左肝蒂阻断法行完全腹腔镜左半肝切除术与开腹手术治疗肝内外胆管结石患者效果比较  

Comparison of complete laparoscopic left hemihepatectomy and traditional open laparotomy with left hepatic pedicle occlusion in treatment of patients with intrahepatic and extrahepatic 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,海口市570100

出　　处：《实用肝脏病杂志》2023年第2期282-285,共4页Journal of Practical Hepatology

基　　金：海南省自然科学基金资助项目(编号:821RC707)。

摘　　要：目的 比较采用左肝蒂阻断法行完全腹腔镜下左半肝切除术与开腹左半肝切除术治疗肝内胆管结石患者的疗效及安全性。方法 2016年1月~2021年12月我院收治的左肝内外胆管结石患者78例,其中45例接受腹腔镜下左肝蒂阻断法行左半肝切除术,另33例接受开腹左肝蒂阻断法行左半肝切除术。结果 腔镜组手术时间为(4.6±0.9)h,显著长于开腹组【(3.6±0.6)h,P<0.05】,术后排气时间和住院日分别为(22.8±8.4)h和(9.4±2.5)d,显著短于开腹组【分别为(44.6±10.5)h和(12.3±3.1)d,P<0.05】,术中出血量为(190.6±45.7)ml,与开腹组的【(212.5±50.4)ml,P>0.05】比,无统计学差异;在术后1 w,腔镜组血清ALT、AST和GGT水平分别为(33.5±6.8)U/L、(43.1±7.4)U/L和(56.0±8.4)U/L,显著低于开腹组【分别为(39.7±5.2)U/L、(50.8±8.2)U/L和(64.2±8.8)U/L,P<0.05】;术后腔镜组出现切口或腹腔感染、胆漏、腹腔积液和肺炎等并发症发生率为4.4%,与开腹组的12.1%比,无统计学差异(P>0.05)。结论 采用完全腹腔镜下左肝蒂阻断法行左半肝切除术治疗肝内外胆管结石患者安全可行,尽管手术时间稍长,但在减少术后创伤、促进术后恢复方面具有明显的优势。Objective The aim of this study was to compare the clinical efficacy of complete laparoscopic left hemihepatectomy and traditional open laparotomy with left hepatic pedicle occlusion in treatment of patients with intrahepatic and extrahepatic bile duct stones. Methods A total of 78 patients with intrahepatic and extrahepatic bile duct stones were admitted to our hospital between January 2016 and December 2021, and out of them, 45 patients underwent laparoscopic left hemihepatectomy with left hepatic pedicle occlusion and 33 patients received open laparotomy with left hepatic pedicle occlusion. Results In patients receiving laparoscopic operation, the operation time was(4.6±0.9) h, significantly longer than [(3.6±0.6) h, P<0.05], the postoperative exhaust time and hospitalization time were(22.8±8.4) h and(9.4±2.5) d, significantly shorter than [(44.6±10.5) h and(12.3±3.1) d, P<0.05] in patients with open operation, while the intraoperative blood loss in the two groups was not significantly different [(190.6±45.7)ml vs.(212.5±50.4)ml, P>0.05];one week after operation, serum ALT, AST and GGT levels in patients receiving laparoscopic operation were(33.5±6.8)U/L,(43.1±7.4)U/L and(56.0±8.4)U/L, much lower than [(39.7±5.2)U/L,(50.8±8.2)U/L and(64.2±8.8)U/L, respectively, P<0.05] in patients receiving open operation;the incidence of postoperative complications, such as incision or abdominal infection, biliary leakage, ascites and pneumonia between the two groups was not statistically significantly different(4.4% vs. 12.1%, P>0.05). Conclusion The application of complete laparoscopic left hemihepatectomy with left hepatic pedicle occlusion is a safe and feasible operation in the treatment of patients with intrahepatic and extrahepatic bile duct stones.

关 键 词：肝内外胆管结石 左半肝切除 腹腔镜手术 开腹手术 左肝蒂阻断 治疗 

分 类 号：R657.3[医药卫生—外科学]