精准肝切除治疗肝内胆管结石

Precise hepatectomy for hepatolithiasis

目的探讨精准肝切除治疗肝内胆管结石的安全性及有效性。方法回顾性分析2013年1月至2017年1月在安徽省立医院行肝切除的93例肝内胆管结石患者临床资料。根据手术方式分为精准肝切除组(精准组,59例)和常规切除组(常规组,34例)。精准组男28例,女31例;平均年龄(56±5)岁。常规组男18例,女16例;年龄(56±4)岁。患者均签署知情同意书,符合医学伦理学规定。两组的手术时间,术中出血量,术后住院时间,术后ALT、AST水平比较采用t检验或Kruskal-Wallis秩和检验,术后并发症发生率比较采用χ~2检验。结果精准组手术时间(210±61)min,明显长于常规组的(157±60)min(t=1.586,P<0.05)。精准组术中出血量(386±99)ml,明显少于常规组的(518±153)ml(t=-1.421,P<0.05)。精准组术后住院时间中位数8(6~10)d,明显低于常规组的10(8~15)d(Z=-2.018,P<0.05)。精准组术后1 d ALT、AST水平分别为(214±87)、(368±106)U/L,明显低于常规组的(594±133)、(625±165)U/L(t=-3.395,-2.047;P<0.05)。精准组术后并发症发生率8.5%(5/59),明显低于常规组的23.5%(8/34)(χ~2=4.066,P<0.05)。结论与传统肝切除相比,精准肝切除治疗肝内胆管结石具有手术创伤小、术中出血量少、术后并发症发生率低等优点,有较好的临床应用价值。

Objective To evaluate the safety and efficacy of precise hepatectomy in treatment of hepatolithiasis. Methods Clinical data of 93 patients with hepatolithiasis who underwent hepatectomy in Anhui Provincial Hospital between January 2013 and January 2017 were analyzed retrospectively. The patients were divided into precise hepatectomy group （precise group, n=59） and conventional resection group （conventional group, n=34） according to different surgical procedures. There were 28 males and 31 females in precise group, with an average age of（56±5） years old. There were 18 males and 16 females in conventional group, with an average age of （56±4） years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The operation time, intraoperative blood loss, postoperative length of stay, postoperative ALT, AST level between two groups were compared by t test or Kruskal-Wallis rank sum test. The incidence of postoperative complication was compared by Chi-square test. Results The operation time was （210±61） min in precise group, significantly longer than （157±60） min in conventional group （t=1.586, P〈0.05）. The intraoperative blood loss was （386±699） ml in precise group, significantly less than （518±153） ml in conventional group （t=-1.421, P〈0.05）. The median postoperative length of stay was 8（6-10） d in precise group, significantly shorter than 10（8-15） d in conventional group （Z=-2.018, P〈0.05）. The ALT and AST level at postoperative 1 d was respectively （214±87） and （368±106） U/L in precise group, significantly lower than （594±133） and （625±165） U/L in conventional group, （t=-3.395, -2.047; P〈0.05）. The incidence of postoperative complication was 8.5% （5/59） in precise group, significantly lower than 23.5%（8/34） in conventional group （Z2=4.066, P〈0.05）. Conelusions Compared with conventional hepatectomy, precise hepatectomy possesses advantages of smaller surgical trauma, less intraoperative blood loss and lower incidence of postoperative complication. It has better clinical application value.