摘要
目的探讨以胆管为导向的腹腔镜肝切除术(laparoscopic Hepatectomy guided by the bile duct,LHGBD)的可行性、安全性及临床效果。方法回顾性分析2016年10月至2020年5月铜陵市人民医院肝胆胰外科实施腹腔镜肝切除术以及开腹肝切除治疗肝内胆管结石病的58例临床资料。使用倾向性评分匹配法(PSM)对开腹肝切除组(OH)和腹腔镜肝切除组(LHCBD)进行1:1匹配,两组各29例,主要观察指标:术前术后肝功能变化、结石分布,有无加行胆总管探查、手术时间、术中出血量、术后住院时间、并发症发生率、胆瘘发生率、结石残留率及结石复发率,胆管狭窄端切除率等。计量资料的比较采用t检验或秩和检验,计数资料的比较采用χ^(2)检验或Fisher确切概率法。结果29例LHCBD组患者中均未中转开腹,术前术后肝功能变化、手术时间、术中出血,术中术后出血无明显区别、但LHGBD组与OH组在术后住院日,术后3天日常护理评估分值,术后并发症,胆瘘发生率分别是(8.6±2.5)d/(11.7±3.7)d(P<0.05),84±0.7/78.4±1.8(P<0.05),24.1%/34.5%(P<0.05),3.4%/27.6%(P<0.05);术后随访3~46个月,平均(15.1±5.6)个月,发现LHGBD组与0H组在结石残留率,胆管狭窄端切除率,结石复发率分别是10.3%/41.4%(P<0.05),82.8%/41.4%(P<0.05),6.9%/44.8%(P<0.05),分别是。结论LHCBD安全、可行,更加便于解剖胆道狭窄端以及狭窄近段肝组织血运,未增加胆瘘发生率,同时降低结石残留复发风险管,有利于降低胆管损伤、出血等并发症的发生率,是治疗肝内胆管结石病安全、有效的手术方式。
Objective To explore the feasibility,safety,and clinical significance of laparoscopic Hepatectomy guided by the bile duct(LHGBD).Methods A retrospective analysis of the clinical data of 58 Hepatolithiasis patients by the Department of Hepatobiliary and Pancreatic Surgery,Tongling People's Hospital from October 2016 to May 2020.The propensity score matching method(PSM)was used to match the open hepatectomy group(OH)and the laparoscopic hepatectomy group(LHGBD)with 1:1,with 29 cases in each group.Main observation indicators:changes in liver function before and after surgery,distribution of stones,with or without additional common bile duct exploration,operation time,intraoperative Bleeding loss,postoperative hospital stay,complication rate,biliary fistula rate,stone residual rate,stone recurrence rate,resection rate of stricture of bile duct,etc.The comparison of measurement data uses t test or rank sum test,and the comparison of count data uses χ^(2) test or Fishers exact probability method。Results None of the 29 patients in the LHCBD group was converted to laparotomy.There was no significant difference in liver function changes before and after surgery,operation time,intraoperative bleeding,and intraoperative bleeding.However,the LHGBD group and the OH group had hospitalization days after surgery.The daily nursing evaluation scores of 3 days after operation,the incidence of postoperative complications and biliary fistula were(8.6±2.5)d/(11.7±3.7)d(P<0.05),84±0.7/78.4±1.8(P<0.05),24.1%/34.5%(P<0.05),3.4%/27.6%(P<0.05);postoperative follow-up for 3~46 months,with an average of(15.1±5.6)months,it was found that the LHGBD group and the OH group were Stone residual rate,bile duct stricture resection rate,and stone recurrence rate were 10.3%/41.4%(P<0.05),82.8%/41.4%(P<0.05),6.9%/44.8%(P<0.05),respectively.Conclusions LHGBD is safe and feasible,and it is more convenient to dissect the blood flow of the biliary stricture and the liver tissue near the stenosis.It does not increase the incidence of biliary fistula.At the same time,it reduces the risk of residual stones and recurrence.The incidence rate is a safe and effective surgical method for the treatment of intrahepatic bile duct stone disease.
作者
雷春
侯亚峰
陈炯
LEI Chun;HOU Ya-feng;CHEN Jiong(Department of General Surgery,Tongling People's Hospital,Tongling 244000,China)
出处
《肝胆外科杂志》
2022年第5期352-355,共4页
Journal of Hepatobiliary Surgery
基金
安徽省铜陵市卫计委资助项目(卫科研[2012]14)。
关键词
腹腔镜肝切除术
肝胆管结石病
并发症
胆管
狭窄
laparoscopic cholecystectomy
hepatolithiasis
complications
bile duct
stricture
