腹腔镜肝切除治疗既往胆道术后肝内胆管结石病的近期疗效  

Short-term efficacy of laparoscopic hepatectomy for recurrent hepatolithiasis patients with previous biliary tract operations

作　　者：魏少明[1] 廖承煜 陈实[3] 黄龙[3] 王耀东[3] 田毅峰[3] Wei Shaoming;Liao Chengyu;Chen Shi;Huang Long;Wang Yaodong;Tian Yifeng(Department of General Surgery,Fujian Provincial Hospital South Branch,Fuzhou 350028,China;Shengli Clinical Medical College of Fujian Medical University,Fuzhou 350001,China;Department of Hepato-Biliary-Pancreatic Surgery,Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院南院普外科,福州350028 [2]福建医科大学省立临床医学院,福州350001 [3]福建省立医院肝胆胰外科,福州350001

出　　处：《创伤与急诊电子杂志》2022年第2期80-87,共8页Journal of Trauma and Emergency(Electronic Version)

摘　　要：目的探讨腹腔镜肝切除术治疗既往行胆道手术的肝内胆管结石病患者的可行性,以期为临床提供建议。方法回顾性分析福建省立医院2015年1月1日至2021年3月31日行肝切除术的既往胆道手术的肝内胆管结石病患者320例患者临床资料,根据本次手术方式分为腹腔镜组(n=120)和开放式手术治疗组(n=200)。评估围术期结局、并发症及残留结石,探讨不同手术入路、手术次数对本次手术效果的影响。结果腹腔镜组失血量、肠道损伤率、胆漏、腹腔出血、腹腔脓肿、再手术率、死亡率和残留结石与开放式手术治疗组相似,两组差异无统计学意义(P>0.05)。腹腔镜组排气时间短、进食早、下床活动早、术后第3天视觉模拟评分评分低、非甾体类解热镇痛抗炎药的使用天数少,明显优于开放式手术治疗组,两组差异有统计学意义(P<0.05)。结论腹腔镜肝切除术对既往行胆道手术的肝内胆管结石病患者是安全有效的,有利于术后早期康复。Objective To investigate the feasibility of laparoscopic hepatectomy in hepatolithiasis patients who underwent previous biliary tract operations with the goal of providing better clinical recommendations.Method In total,320 patients with previous biliary tract operations who underwent hepatectomy from January 1,2015 to March 31,2021 were enrolled and divided into the laparoscopic group(n=120)and the open surgery group(n=200)according to the operation method.The perioperative outcomes,complications and residual stones were evaluated.Moreover,the impacts of different sequences of surgical approaches,numbers of operations were investigated.Result The amount of blood loss,intestinal injury,biliary leakage,abdominal bleeding,abdominal abscess,reoperation rate,mortality and residual stones in the laparoscopic group were similar to those in the open surgery group,and there was no significant difference between the two groups(P>0.05).Except for right half hepatectomy,other hepatectomies in the laparoscopic group had shorter exhaust time,earlier food intake,earlier out-of-bed activity,lower visual analog scores on the third day after surgery,and fewer days of use of nonsteroidal-anti-inflammatory drugs(NSAIDs),which were significantly better than the open surgery group(P<0.05).Conclusion Laparoscopic hepatectomy is safe,effective and beneficial to patients’early postoperative recovery.

关 键 词：腹腔镜 肝内胆管结石病 肝切除术 胆道手术史 粘连 

分 类 号：R657.4[医药卫生—外科学]