腹腔镜肝切除术在肝内胆管结石治疗中的临床应用

Clinical application of laparoscopic hepatectomy for hepatolithiasis

目的评价腹腔镜肝切除术治疗肝内胆管结石的临床疗效。方法2009年3月至2012年6月我院收治的31例肝内胆管结石患者，行腹腔镜肝切除术（腹腔镜组），同期25例肝内胆管结石患者行开腹肝切除术（开腹组），观察并比较两组手术时间、术中出血量、住院时间及并发症。结果两组患者均成功完成手术，腹腔镜组手术时间[（247-3±85．9）min]、术中出血量[（603．6±388．7）m1]与开腹组[（235．1±78．6）min、（657．2±372．8）m1]比较，差异无统计学意义（P〉0．05），腹腔镜组患者住院时问[（6．2±2．6）d]较开腹手术组[（10．7±2．7）d]显著缩短（P〈O．05）。两组在术后并发症发生率方面比较差异有统计学意义（12．2％VS．31．7％，P〈0．05）。两组均无围手术期死亡病例。结论腹腔镜肝切除术治疗肝内胆管结石是安全可行的，具有微创、住院时间短等优点，疗效与开腹手术相当。

Objective To explore the clinical efficacy of laparoscopic hepatectomy for hepatolithiasis. Methods 31 patients with hepatolithiasis who had treated during the period of March 2009 to June 2012 received laparoscopic hepatectomy, 25 patients with hepatolithiasis at the same period received laparotomic hepatectomy. Surgial duration, intraoperative bleeding volume, length of hospital stay, and complications were observed and then compared between the two groups. Results The procedures were successfully performed on all the patients. There were no significant differences between the two groups in the surgical duration and intraoperatiev bleeding volume （P〉O.05）; the length of hospital stay was significantly shorter in the group of laparoscopic hepatectomy than in the group of laparotomic hepatectomy （P〈0.05）; and there was no statistical difference in the rate of complications between the two groups （P〉O.05）. No death occurred perioperatively.Conclusions Laparoscopic hepatectomy surgery is feasible and safe for treatment of hepatolithiasis, with advantages of less invasion and shorter hospital stay. Its efficacy is similar to laparotomic hepatectomy.