全腹腔镜与开腹规则性左肝切除术治疗肝胆管结石的比较研究-《中国微创外科杂志》

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Title:: A Comparative Study on Laparoscopic and Open Anatomical Left Hepatectomy in the Treatment of Hepatolithiasis

作者:: 谢元才; 叶荣强**; 钟鼎文; 邓小红; 何勇; 江西省赣州市人民医院肝胆外科，赣州341000

Author(s):: Xie Yuancai; Ye Rongqiang; Zhong Dingwen; et al.; Department of Hepatobiliary Surgery, Ganzhou People’s Hospital, Ganzhou 341000, China

关键词:: 腹腔镜肝切除术; 规则性左肝切除; 肝胆管结石

Keywords:: Laparoscopic hepatectomy; Anatomical left hepatectomy; Hepatolithiasis

文献标志码:: A

摘要:: 目的探讨全腹腔镜规则性左肝切除治疗肝胆管结石的安全性与有效性。方法选取我院2011年1月~2016年1月肝胆管结石行规则性左肝切除104例，其中全腹腔镜规则性左肝切除33例（腹腔镜组），开腹手术71例（开腹组），比较2组手术时间、术中出血、术后恢复饮食时间、术后住院时间、术后白蛋白使用情况、术后并发症、一期清石率、总清石率等。结果腹腔镜组手术时间明显长于开腹组［（199.4±62.9) min vs. (173.6±36.6)min, t=2.635，P=0.010］，术后恢复饮食时间明显短于开腹组［（1.7±0.9) d vs.(3.1±0.9)d，t=-7.383，P=0.000］,术后住院时间明显短于开腹组［（7.9±2.3)d vs.(10.1±2.8)d，t=-3.936，P=0.000］。腹腔镜组术后白蛋白使用率明显低于开腹组［12.1%（4/33） vs. 39.4%（28/71）, χ2=7.891，P=0.005］。腹腔镜组术后第1、3天WBC计数明显低于开腹组［（11.5±1.2)×109/L vs.(14.9±2.1)×109/L，t=-8.653，P=0.000；（8.9±1.8)×109/L vs.（11.0±2.0)×109/L，t=-5.139，P=0.000］；术后第1、3天CRP明显低于开腹组［（28.4±3.9）mg/L vs. (58.8±20.4)mg/L,t=-8.468,P=0.000；(13.2±3.2)mg/L vs. (30.9±7.6)mg/L ,t=-12.834，P=0.000］；术后第1、3天ALB明显高于开腹组［（33.0±2.7）g/L vs. (31.1±3.1)g/L,t=3.026，P=0003；(35.2±1.8)g/L vs.(33.6±2.4)g/L，t=3.407，P=0.000］。2组出血量［（213.4±169.3）ml vs.(240.8±91.9) ml ,t=-1.069，P=0.287］、肝切除方式（χ2=3.625，P=0.057）、术后第1和3天TBIL>17.1 μmol/L百分比［45.4%（15/33） vs. 38.0%（27/71）, χ2=0.516，P=0.473； 30.3%（10/33） vs. 23.9%（17/71）, χ2=0.474，P=0.491］、术后1和3天ALT［（99.2±31.8）U/L vs.(107.9±41.1)U/L，t=-1.075，P=0.285；(56.1±14.2) U/L vs.(65.2±31.9)U/L,t=-1.565，P=0.121］、术后1和3天AST［（77.7±25.9） U/L vs.(87.0±35.0) U/L ,t=-1.362，P=0.176；(45.0±9.3) U/L vs.(511±18.8) U/L ,t=-1.763，P=0.081］、术后清石率［一期清石率84.3%（28/33） vs. 87.8%（62/71）, χ2=0.001,P=0.972；最终清石率100.0%(33/33) vs. 97.2%(69/72), Fisher精确检验，P=1.000］均无统计学差异。2组术后并发症发生率无统计学差异［12.1%（4/33）vs. 21.1%（15/71）， χ2=1.224，P=0.269］。结论腹腔镜规则性左肝切除术治疗肝胆管结石安全、有效。

Abstract:: ObjectiveTo evaluate the safety and effectiveness of laparoscopic anatomical left hepatectomy in the treatment of hepatolithiasis.MethodsA total of 104 patients receiving anatomical left hepatectomy from January 2011 to January 2016 were divided into either laparoscopic hepatectomy (LH) group (33 cases) or open hepatectomy (OH) group (71 cases). Data of two groups were compared, which included intraoperative indicators (operation time, intraoperative bleeding), postoperative conditions (time to postoperative recovery of diet, postoperative hospitalization days, postoperative usage of albumin, and postoperative complication), and operation effects (first stage stone clearance rate, final stone clearance rate).ResultsThe LH group had longer operation time ［(1994±62.9) min vs. (173.6±36.6) min, t=2.635, P=0.010］, shorter time of postoperative recovery of diet ［(1.7±0.9) d vs. (3.1±0.9) d,t=-7.383, P=0.000］, shorter postoperative hospitalization days ［(7.9±2.3) d vs. (10.1±2.8) d, t=-3.936, P=0.000］, less postoperative usage of albumin ［12.1% (4/33) vs. 39.4% (28/71), χ2=7.891, P=0.005］, lower levels of white blood cell count on the first and third postoperative days ［(11.5±1.2)×109/L vs. (14.9±2.1)×109/L, t=-8.653, P=0.000; (8.9±1.8)×109/L vs. (11.0±2.0)×109/L, t=-5.139, P=0.000］ and CRP values ［(28.4±3.9) mg/L vs. (58.8±20.4) mg/L, t=-8.468, P=0.000; (13.2±3.2) mg/L vs. (30.9±7.6) mg/L, t=-12834, P=0000］, and higher levels of albumin values on the first and third postoperative days ［(33.0±2.7) g/L vs. (31.1±3.1) g/L, t=3.026, P=0.003; (35.2±1.8) g/L vs.(33.6±2.4) g/L, t=3.407, P=0.000］. There were no statistical differences in intraoperative bleeding ［(213.4±169.3) ml vs. (240.8±91.9) ml, t=-1.069, P=0.287］, operation mode (χ2=3.625, P=0.057), case number of TBIL value higher than 17.1 μmol/L on the first and third postoperative days ［45.4% (15/33) vs. 38.0% (27/71), χ2=0.516, P=0.473; 30.3%(10/33) vs. 23.9%(17/71), χ2=0.474, P=0.491］, values of ALT on the first and third postoperative days ［(99.2±31.8) U/L vs.(107.9±41.1) U/L, t=-1.075, P=0.285; (56.1±142) U/L vs. (65.2±31.9) U/L, t=-1.565, P=0.121］ and AST on the first and third postoperative days ［(77.7±25.9) U/L vs.(87.0±35.0) U/L, t=-1.362, P=0.176; (45.0±9.3) U/L vs. (51.1±18.8) U/L, t=-1.763, P=0.081］, and operation effects ［first stage stone clearance rate: 84.3% (28/33) vs. 87.8% (62/71), χ2=0.001, P=0.972; final stone clearance rate: 100.0% (33/33) vs. 972% (69/72), Fisher’s exact test, P=1.000］. There was no statistical difference in operative complication rate ［12.1% (4/33) vs. 21.1% (15/71), χ2=1.224, P=0.269］.ConclusionLaparoscopic anatomical left hepatectomy is a safe and effetive procedure in hepatolithiasis patients.

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