腹腔镜肝切除术治疗肝内胆管结石病患者临床疗效研究  

Clinical efficacy of laparoscopic hepatectomy in the treatment of patients with intrahepatic bile duct stones

作　　者：尹秋实[1] 王学国 宋奇锋 Yin Qiushi;Wang Xueguo;Song Qifeng(Department of Hepatobiliary and Pancreatic Surgery,First Affiliated Hospital,Hainan Medical College,Haikou 570100,Hainan Province,China)

机构地区：[1]海南医学院第一附属医院肝胆胰外科,海口市570100 [2]海南医学院第二附属医院肝胆胰外科

出　　处：《实用肝脏病杂志》2023年第1期124-127,共4页Journal of Practical Hepatology

基　　金：海南省自然科学基金基础与应用研究计划项目(编号:821RC707)

摘　　要：目的比较先行腹腔镜肝切除(LH)还是先行胆总管切开取石治疗肝内胆管结石病(IHC)患者的临床效果.方法2017年1月~2021年10月我院诊治的IHC患者90例,其中合并胆总管结石79例.在53例A组,先行LH术,再行胆总管切开取石,在37例B组先行胆总管切开取石再进行LH,随访6个月.结果A组手术时间、术后引流管拔除时间和术后住院日分别为(226.1±45.3)min、(7.1±1.8)d和(8.0±1.5)d,显著短于B组[分别为(294.5±58.8)min、(8.4±2.0)d和(9.7±2.4)d,P<0.05],术中出血量为(215.4±39.7)ml,也显著少于B组[(328.2±37.2)ml,P<0.05];术前术后两组血清ALT、AST、ALP和TBIL水平无显著性差异(P>0.05);随访3个月,两组术后切口感染、腹腔积液、胆漏、胆道出血和胆管炎并发症发生率比较,差异无统计学意义(13.2%对24.3%,P>0.05);随访6个月,A组结石复发率为5.7%,与B组的8.1%比,差异无统计学意义(P>0.05).结论对于合并胆总管结石的IHC患者是先行LH还是先行胆总管切口取石可能不影响治疗效果,而需要根据患者腹腔情况作出选择.外科医生需要总结经验,给出合理的手术路径,以提高手术效率和治疗结果.Objective The aim of this study was to compare the clinical efficacy of first laparoscopic hepatectomy(LH)and thereafter common bile duct incision for stone removal,or vice versa in the treatment of patients with intrahepatic bile duct stones(IHBDS).Methods 90 patients with IHBDS were enrolled in our hospital between January 2017 and October 2021,and the 53 patients in group A received first LH and thereafter common bile duct incision for stone removal and 37 patients in group B received first common bile duct incision for stone removal and thereafter LH.All patients were followed-up for six months.Results The surgical time,postoperative drainage tube removal and postoperative hospital stay in group A were(226.1±45.3)min,(7.1±1.8)d and(8.0±1.5)d,all significantly shorter than[(294.5±58.8)min,(8.4±2.0)d and(9.7±2.4)d,respectively,P<0.05],and intraoperative blood loss was(215.4±39.7)ml,also significantly less than[(328.2±37.2)ml,P<0.05]in group B;there were no significant differences as respect to blood biochemical parameters between the two groups at presentation and 5 days after operation(P>0.05);at the end of three month follow-up,the incidences of post-operational complications,such as incision infection,ascites,bile leakage,biliary bleeding and cholangitis between the two groups were not significantly different(13.2%vs.24.3%,P>0.05);at the end of six month follow-up,the stone recurrence rates were not statistically significant between the two groups(5.7%vs 8.1%,P>0.05).Conclusion The first LH and thereafter common bile duct incision for stone removal,or vice versa in the treatment of patients with IHBDS could not lead to a different outcomes of patients,and the surgeons might make the decisions based the patients’conditions.We vigorously recommend them to summarize the clinical experiences to give out the indications.

关 键 词：肝内胆管结石病 腹腔镜肝切除术 胆总管切除取石 治疗 

分 类 号：R657.3[医药卫生—外科学]