左肝蒂阻断行腹腔镜左半肝切除术治疗肝内胆管结石疗效研究

Therapeutic Effect of Left Hepatic Pedicle Blockade on Laparoscopic Left Hepatectomy for Intrahepatic Bile Duct Stones

目的探讨腹腔镜左肝蒂阻断左半肝切除术治疗肝内胆管结石患者的疗效。方法回顾性分析2016年10月～2018年3月在承德医学院附属医院肝胆外科行手术治疗的67例肝内胆管结石患者的临床资料,其中35例行左肝蒂阻断腹腔镜左半肝切除术治疗设为腔镜组,32例行传统开腹左半肝切除术治疗设为开腹组,比较两组的手术时间、术中出血量、术后镇痛时间、胃肠恢复时间、术后住院时间、住院费用、术后并发症和术后第7天的白蛋白(ALB)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)变化情况。结果腔镜组手术时间较开腹组长[(269.11±54.43) min vs(211.72±31.64) min],术后疼痛缓解时间[(2.89±1.41) d vs(4.81±1.58) d],术后排气时间[(24.80±6.31) h vs(45.13±9.80)h],术后住院时间[(9.51±2.38) d vs(14.19±2.86) d]均优于开腹组,差异均具有统计学意义(P<0.05);两组患者手术出血量、并发症和住院总费用比较,差异无统计学意义(P>0.05);治疗后两组肝功能指标比较,差异无统计学意义(P>0.05)。结论腹腔镜下左肝蒂阻断左半肝切除术治疗肝内胆管结石的疗效与安全性是肯定的,与以往开腹肝切除术相比,腹腔镜左肝蒂阻断左半肝切除术创伤更小,并发症更少,术后恢复更快。

Objective To investigate the efficacy of laparoscopic left hepatic pedicle blockade for left hepatectomy in patients with intrahepatic bile duct stones.Methods The clinical data of 67 patients with intrahepatic bile duct stones who underwent surgical treatment of hepatobiliary surgery in the Affiliated Hospital of Chengde Medical College from October 2016 to March 2018 were retrospectively analyzed.35 patients underwent left hepatic pedicle obstruction of laparoscopic left hepatic liver.The resection was performed in the laparoscopic group,and 32 patients underwent conventional open left hepatectomy.The operation time,intraoperative blood loss,postoperative analgesia time,gastrointestinal recovery time,Postoperative hospital stay,hospitalization costs,postoperative complications,and albumin(ALB),total bilirubin(TBIL),alanine aminotransferase(ALT),and aspartate aminotransferase on day 7 postoperatively(AST)changes.Results The operation time of the laparoscopic group was longer than that of the open group[(269.11±54.43)min vs(211.72±31.64)min],postoperative pain relief time[(2.89±1.41)d vs(4.81±1.58)d],postoperative row Gas time[(24.80±6.31)h vs(45.13±9.80)h],postoperative hospital stay[(9.51±2.38)d vs(14.19±2.86)d]was better than open group,the difference was statistically significant.(P<0.05);There was no significant difference in the amount of surgical bleeding,complications and total hospitalization between the two groups(P>0.05).There was no significant difference in liver function between the two groups after treatment(P>0.05).Conclusion The efficacy and safety of laparoscopic left hepatic pedicle blockade for left hepatectomy in the treatment of intrahepatic bile duct stones is positive.Compared with previous open liver resection,laparoscopic left hepatic pedicle block left hepatectomy Less trauma,fewer complications,and faster recovery after surgery.