【摘要】 目的探讨应用腹腔镜肝切除术治疗肝内胆管结石的可行性和治疗效果。方法回顾性分析该院2003年11月至2012年11月75例肝内胆管结石患者的手术治疗。其中35例患者进行腹腔镜肝切除术(腹腔镜组),40例患者采用开腹肝切除术进行治疗(开腹组)。两组患者的手术方式包括左肝外叶切除术、左半肝切除术、胆总管切开探查、胆道镜探查取石、T管引流、胆囊切除。分析和对比两组患者的临床指标,包括手术时间、术中出血量、止痛药使用情况、下床活动时间、恢复饮食时间、术后住院时间、并发症、结石清除率以及复发率。结果腹腔镜组的手术时间长于开腹组[(205.0±40.9)min vs.(155.0±26.6)min,P<0.01]。腹腔镜组的术后住院时间比开腹组短[(12.3±2.6)d vs.(15.6±4.3)d,P<0.01];术中出血量稍多于开腹手术组[(330.0±259.7)mL vs.(151.5±137.0)mL,P<0.01],然而腹腔镜组后10例患者的出血量与开腹组相当[(81.0±19.7)mL vs.(78.0±22.0)mL,P>0.05]。腹腔镜组术后止痛药使用率低于开腹组(0vs.62.5%,P<0.01);比开腹组更早地恢复下床活动[(1.5±0.5)d vs.(3.6±0.7)d,P<0.01]和进食[(2.4±0.5)d vs.(4.0±0.7)d,P<0.01]。两组总并发症发生率(2.9%vs.16.0%)、结石清除率(即时清除率91.4%vs.90%和最终清除率97.1%vs.100%)及手术优良率(97.1%vs.100%)差异无统计学意义(P>0.05),且均无围术期死亡病例。结论对于符合入选标准的病例,腹腔镜肝切除术联合胆道镜治疗肝内胆管结石是安全可行的,可以达到与开腹手术同样良好的效果。腹腔镜肝切除治疗肝内胆管结石具有伤口小、痛苦轻、恢复快、并发症少等微创手术的优势。更多还原

【Abstract】 Objective To explore the feasibility and therapeutic effect of total laparoscopic hepatectomy(LH)for treating hepatolithiasis.Methods 75 consecutive patients with hepatolithiasis operatively treated in our hospital from November 2003 to November 2012 were retrospectively analyzed.Among them,35 cases underwent laparoscopic hepatectomy(LH group)and 40 cases underwent open hepatectomies(OH group).The operative modes in the two groups included the left liver lateral lobe resection,left hemihepatecomy,common bile duct incision exploration,choledochoscopy exploration for calculi extraction,T tube drainage and cholecystectomy.The clinical indicators including the operation time,intraoperative blood loss,analgesic drug use situation,ambulation time,diet recovery time,postoperative complication rate,postoperative hospital stay time,stone clearance rate and recurrence rate were analyzed and compared between the two groups.Results The operation time of the LH group was longer than that of the OH group[(205.0±40.9)min vs.(155.0±26.6)min,P<0.01]and the postoperative hospital stay time of the LH group was shorter than that of the OH group[(12.3±2.6)d vs.(15.6±4.3)d,P<0.01].The intraoperative blood loss of the LH group was slightly more than that of the OH group[(330.0±259.7)mL vs.(151.5±137.0)mL,P<0.01].However,the blood loss of last 10 cases in the LH group was similar to that of the OH group[(81.0±19.70)mL vs.(78.0±22.0)mL,P>0.05).The use rate of analgesic drugs in the LH group was lower than that of the OH group(0vs.62.5%).The ambulation time and the diet recovery time in the LH group were shorter than those in the OH group[(1.5±0.5)d vs.(3.6±0.7)d,P<0.01;(2.4±0.5)d vs.(4.0±0.7)d,P<0.01].No differences between the two groups were found in the occurrence rate of postoperative complications(2.9% vs.16.0%),stone clearance rate(instant clearance rate 91.4%vs.90%;final clearance rate 97.1% vs.100%)and the opeartion excellent rate(97.1%vs.100%).No case of perioperative death occurred in the two groups(P>0.05).Conclusion LH combined with choledochoscopy for treating hepatolithiasis is feasible and safe in the patients conforming to the selected standard with an equal therapeutic effect to that of open hepatectomy.LH has the advanteages of minimally invasive surgery such as small incision,less pain,fast recovery,less complications,etc.更多还原