腹腔镜中路纵剖法取石术治疗复杂性肝胆结石

Laparoscopic Middle-section Longitudinal Approach for Clearance of Complicated Hepatobiliary Stones

目的探讨腹腔镜中路纵剖法取石术治疗复杂性肝胆结石的效果。方法选取我院2016年1月~2017年9月收治的复杂性肝内胆管结石患者80例,按随机数字表分为观察组和对照组,每组各40例。观察组采用中路纵剖法行腹腔镜取石术,对照组采用传统的腹腔镜取石术,比较两组患者手术相关指标以及并发症发生情况。结果观察组中转开腹率(2.50%)明显低于对照组(12.50%),差异有统计学意义(χ^2=13.206,P<0.05)。两组手术时间、术中出血量和术后排气时间比较,差异均无统计学意义(P>0.05);观察组住院时间明显短于对照组,差异有统计学意义(P<0.05)。观察组患者术后仅1例肝门区积液,对照组出现胆管出血3例,伤口感染、肝门区积液、胆漏及黄疸各1例。两组并发症率比较,观察组低于对照组,差异有统计学意义(2.56% vs. 20%,P<0.05)。结论采用中路纵剖法行腹腔镜取石术治疗复杂性肝胆结石较传统手术在分离和暴露Calot三角中具有更高的安全性,且可缩短住院时间,值得临床进一步推广应用。

Objective To explore the effect and safety of laparoscopic middle-section longitudinal approach for clearance of complicated hepatobiliary stones.Methods A total of eighty patients with complicated intrahepatic bile duct stones diagnosed in our hospital from January 2016 to September 2017 were divided into two groups randomly according to the random number table,with 40 cases for each.Laparoscopic lithotripsy was performed by middle-section longitudinal approach in the observation group,and the conventional laparoscopic lithotripsy was carried out in the control group.The surgical related indexes and complications were compared between the two groups.Results The rate of conversion to open surgery was 2.50% in the observation group,and was significantly lower than 12.50% in the control group,and the difference was statistically (χ^2=13.206,P <0.05).There was no statistical difference in the operative time,intra-operative blood loss volume and post-operative gastrointestinal recovery time between the two groups (P>0.05),but the hospital stays of the observation group was significantly shorter than that of the control group,and the difference was statistically (P<0.05).The hydrops of porta hepatis was found in one case in the observation group,and bile duct bleeding was in 3 cases,wound infection,portal hepatis hydrops,bile leak and jaundice in one case respectively in the control group.The incidence of post-operative complications of the observation group was significantly lower than the control group,and the difference was statistically (2.56% vs.20%,P <0.05).Conclusion Laparoscopic middle-section longitudinal approach for clearance of complicated hepatobiliary stones is safer than traditional laparoscopic surgery in dissecting and exposing the Calot triangle and can shorten the length of hospital stays,which is worthy of further clinical application.