腹腔镜规则性左半肝切除治疗胆管结石的疗效

Treatment of choledocholithiasis by laparoscopic regular left hepatectomy

目的探讨腹腔镜规则性左半肝切除治疗左肝胆管结石的临床疗效以及安全性。方法回顾性分析2006年1月-2012年12月仙桃市第一人民医院收治的左肝胆管结石的患者72例,其中行腹腔镜规则性左半肝切除术治疗患者36例为观察组,行开腹左半肝切除术治疗患者36例为对照组,比较两组手术中出血量、手术进行时间、术后排气时间、术后引流管拔管时间、术后住院时间及术后不良反应。结果两组手术均顺利完成。两组手术进行时间、术中出血量比较差异无统计学意义(P>0.05);观察组术后排气时间、腹腔引流量、术后引流管拔管时间以及术后住院时间均明显优于对照组,差异有统计学意义(P<0.05);观察组在发热及伤口感染率方面均明显低于对照组,差异有统计学意义(P<0.05)。结论相较于传统开腹左半肝切除,腹腔镜规则性左半肝切除治疗左肝胆管结石具有创伤小、安全性高、术后恢复快的特点,临床应用值得推广。

Objective To explore the clinical efficacy and safety of laparoscopic left hepatectomy for left hepatolithiasis. Methods A retrospective analysis of 72 patients with left hepatic bile duct stones treated in Xiantao First People ＂s Hospital from January 2006 to December 2012. 36 cases as the observation group underwent laparoscopic anatomical left half liver resection and 36 cases as the control group underwent open left half liver resection. They were compared between the two groups with amount of bleeding in surgery, the operation time, postoperative exhaust time, postoperative drainage tube extubation time, postoperative hospital stay and postoperative adverse reactions. Results The two groups of patients were successfully completed surgery. The differences of operation time, amount of bleeding in surgery amount two groups were not statistically significant （P〉0.05）; The postoperative exhaust time, abdominal drainage volume, postoperative drainage extuhation time and postoperative hospital stay of the observation group were significantly better than those of the control group （P〈0.05）; The fever and wound infection rate of the observation group were significantly lower than those of the control group （1~〈0.05）. Conclusion Compared with open left hepatectomy in treatment of hepatolithiasis, laparoscopic anatomical left hepatectomy is worthy of clinical application with the characteristic of small trauma, high safety, fast postoperative recovery.