倾向性评分匹配腹腔镜肝叶切除术与开腹术治疗合并肝硬化的肝胆管结石患者临床疗效研究  

Laparoscopic hepatectomy in treatment of patients with cholangiolithiasis and underlying compensated liver cirrhosis:a comparative study with open approach

作　　者：王兵[1] 肖元初[1] 孙振纲[1] 王帅[1] Wang Bing;Xiao Yuanchu;Sun Zhengang(Department of Hepatobiliary Pancreatic and Splentic Surgery,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou 434020,Hubei Province,China)

机构地区：[1]长江大学附属荆州医院肝胆胰脾外科,湖北省荆州市434020

出　　处：《实用肝脏病杂志》2024年第2期303-306,共4页Journal of Practical Hepatology

基　　金：湖北省自然科学基金资助项目(编号:2022CFB346)。

摘　　要：目的探讨腹腔镜肝叶切除术治疗合并肝硬化的肝胆管结石患者的临床疗效。方法2018年6月~2023年6月长江大学附属荆州医院肝胆胰脾外科诊治的合并肝硬化的肝胆管结石患者59例,其中20例接受开腹手术,采用倾向性评分匹配原则选择另20例接受腹腔镜手术,两组均行肝叶切除术。结果两组体质指数、肝硬化病因和既往手术史均匹配成功,两组均顺利完成手术,腹腔镜组无中转开腹者;腹腔镜手术组手术时间为(182.6±97.2)min,显著长于开腹组【(170.6±95.7)min,P<0.05】,但术中出血量和肝门阻断时间分别为(203.5±186.6)ml和(32.3±21.4)min,显著少于或短于开腹组【分别为(232.2±195.3)ml和(40.6±28.8)min,P<0.05】;腹腔镜组术后住院日为(8.6±5.7)d,显著短于开腹组【(11.5±3.9)d,P<0.05】,而两组T管日引流量、术后进食时间和下床时间均无显著性差异(P>0.05);腹腔镜组并发症发生率为15.0%,而开腹组为30.0%(P>0.05)。结论腹腔镜肝叶切除术治疗合并肝硬化的肝胆管结石患者临床疗效不亚于传统的开腹手术,而且更加微创,是一种安全、有效的治疗手段。Objective This study was to explore the clinical efficacy of laparoscopic hepatectomy(LH)in treating patients with cholangiolithiasis and underlying liver cirrhosis.Methods 59 patients with cholangiolithiasis were recruited in Jingzhou Hospital Affiliated to Yangtze University between June 2018 and June 2023,and all the patients enrolled had underlying compensated liver cirrhosis.20 patients underwent open hepatectomy(OH),and other 20 patients selected by propensity score matching underwent LH.Results The patients in the two groups were matched successfully on body mass index,the etiologies of liver cirrhosis and surgery history,and all operations were successfully completed without switch to OH in LH-treated patients;the surgery time in patients receiving LH was(182.6±97.2)min,much longer than[(170.6±95.7)min,P<0.05],while the intraoperative blood loss and the hepatic inflow occlusion time were(203.5±186.6)ml and(32.3±21.4)min,significantly less or shorter than[(232.2±195.3)ml and(40.6±28.8)min,respectively,P<0.05]in patients receiving OH operation;the post-operational hospital stay in patient receiving LH was(8.6±5.7)d,much shorter than[(11.5±3.9)d,P<0.05]in patients underwent OH,while the daily T-tube drainage volumes,postoperative feeding times and mobilization times in the two groups were not significantly different(P>0.05);the incidence of post-operational complications in patients receiving LH was 15.0%,not significantly different compared to 30.0%(P>0.05)in patients receiving OH.Conclusion The laparoscopic hepatectomy in the treatment of patients with cholangiolithiasis and underlying liver cirrhosis is as efficacious as traditional open surgery,with minimally invasive operation virtue,and warrants further clinical verification.

关 键 词：肝胆管结石 肝硬化 腹腔镜 肝叶切除 治疗 

分 类 号：R657.42[医药卫生—外科学] R657.31[医药卫生—临床医学]