全腹腔镜肝叶切除联合经皮经肝胆道硬镜治疗左肝内胆管结石的效果

Effect of stylized laparoscopic left hemihepatectomy combined with stone extraction by percutaneous transhepatic cholangioscopy in the treatment of Left Intrahepatic Bile Duct Stones

目的 探讨模式化全腹腔镜肝叶切除联合经皮经肝胆道硬镜碎石治疗左肝内胆管结石的临床疗效。方法 回顾性选取2015年1月至2017年12月期间100例左肝内胆管结石患者为研究对象,根据手术方式分为腹腔镜联合胆道镜组(腔镜组, n =50)和开腹联合胆道镜组(开腹组, n =50),采用SPSS19.0软件进行数据分析。术中术后等计量资料采用均数±标准差描述,组间比较采用独立 t 检验;术后残石、并发症、近期疗效和复发情况等分类资料和有序资料组间比较采用 Pearson χ 2 检验、 Kruskal-Wallis 检验。 P <0.05为差异有统计学意义。结果 两组的手术时间差异无统计学意义( P >0.05);腔镜组术中出血量、术后下床锻炼时间、肠道排气时间和住院时间显著优于开腹组( P <0.05);两组患者术后2周的ALT、AST、TBIL水平均较术前显著下降,且腔镜组的ALT、AST水平显著低于开腹组( P <0.05);腔镜组总并发症发生率显著低于开腹组(10.0% vs. 26.0%), P <0.05;腔镜组的近期疗效显著优于开腹组( P <0.05),两组的术后1年复发率差异无统计学意义( P >0.05)。结论 模式化全腹腔镜肝叶切除联合经皮经肝胆道硬镜取石术治疗左肝内胆管结石安全有效,具有术后恢复快、并发症少、临床疗效好的优点,具有较好的临床使用价值。

Objective To investigate the clinical effect of stylized laparoscopic left hemihepatectomy combined with stone extraction by percutaneous transhepatic cholangioscopy in the treatment of Left Intrahepatic Bile Duct Stones. Methods 100 cases of left intrahepatic cholangiolithiasis treated in our hospital from January 2015 to December 2017 were retrospectively analyzed. According to the surgical methods , they were divided into laparoscopy combined choledochoscopy group (observation group, n =50) and laparotomy combined choledochoscopy group (control group, n =50). SPSS19.0 software was used for data analysis. The intraoperative and postoperative measurements were described by (±s), and compared by independent t test. Pearson χ 2 test and Kruskal-Wallis test were used to compare the classified and ordered data of postoperative residual stones, complications, short-term efficacy and recurrence. P <0.05 was statistically significant. Results There was no significant difference in the operation time between the observation group and the control group ( P >0.05). The amount of bleeding, the time of ambulation after operation, the recovery time of intestinal function and the time of hospitalization in the observation group were significantly better than those in the control group ( P <0.05). The levels of ALT, AST and TBIL in the observation group and the control group decreased significantly after 2 weeks of the operation, and the levels of ALT and AST in the observation group were significantly lower than those in the control group ( P <0.05). The incidence of complications in the observation group was significantly lower than that of the control group (10.0% vs. 26.0%)( P <0.05). The short-term effect of the observation group was significantly better than that of the control group (P < 0.05). There was no significant difference in the recurrence rate between two groups after 1 year of the operation ( P > 0.05). Conclusion Compared with traditional laparotomy, stylized laparoscopic left hemihepatectomy combined with stone extraction by percutaneous transhepatic cholangioscopy is safe and effective for the treatment of left intrahepatic bile duct stones. It has the advantages of quick recovery, less complications and better clinical efficacy. It has good clinical value.