腹腔镜肝切除治疗肝内胆管结石的临床研究

Clinical Study of Laparoscopic Hepatectomy in the Treatment of Calculus of Intrahepatic Duct

目的:探讨腹腔镜肝切除治疗肝内胆管结石的可行性、安全性及临床疗效。方法:选取我院2009年6月至2013年12月32例行腹腔镜肝切除治疗肝内胆管结石的患者作为腹腔镜组,并选择同时期内的32例行开腹肝切除治疗肝内胆管结石的患者作为开腹组。比较两组患者的术中情况及术后恢复情况。结果:腹腔镜组与开腹组在肝切除方式、术中失血量、术中和最终结石清除率、结石复发率、胆管炎复发率等方面无明显差异(P>0.05);腹腔镜组的手术时间长于开腹组,但腹腔镜组术后第一次下床时间、术后镇痛时间、首次进食时间、术后平均住院天数均少于开腹组,有统计学意义(P<0.05)。结论:与传统开腹肝切除术治疗肝内胆管结石相比,腹腔镜肝切除术安全可行,具有创伤小、术后恢复快、住院时间短等优点,并且可以达到与传统开腹手术相同的治疗效果。

Objective： To investigate the safety,feasibility and therapeutic effect of laparoscopic hepatectomy in treatment of hepatolithisasis. Method： 32 cases from June 2009 to December 2013 received laparoscopic hepatectomy for hepatolithisasis were selected as laparoscopic group,and at the same time,32 cases undergoing open hepatectomy as laparotomy group. The intraoperation situation and postoperative recovery condition were analyzed and compared between the two groups. Result： There was no significant difference between laparoscopy and laparotomy group about the way of liver resection,intraoperative blood loss,intraoperative and final clearance,the rate of stones recurrence and cholangitis recurrent（ P〈0. 05）. The surgery time in laparoscope group that was longer than laparotomy group,but the first time of getting out of bed for the first time after operation,postoperative analgesia time,first eating time and average postoperative hospital stay were less than those in laparotomy group（ P〈0. 05）. Conclusion： Compared with the traditional open operation,laparoscopic hepatectomy is a feasible and safe method for the treatment of hepatolithiasis,with the merits of less wound,quick rehabilitation and shorter hospitalization. This method is similar with traditional open hepatectomy in therapeutic effect for hepatolithiasis.