不同手术方式在治疗特殊部位的左肝胆管结石中的应用价值

Application value of different operation methods in the treatment of left hepatolithiasis in special position

目的研究不同手术方式在治疗特殊部位(影像学上结石位于门静脉左支矢状段和肝左静脉近端附近)的左肝胆管结石中的应用价值。方法回顾性分析2015年7月—2018年6月湖北省天门市第一人民医院普外科58例特殊部位的左肝胆管结石患者临床资料,根据手术方式的不同分为两组,即腹腔镜下左肝外叶切除术+胆总管切开取石术组(左肝外叶切除术组,n=28)和腹腔镜下左半肝切除术+胆总管切开取石术组(左半肝切除组,n=30)。比较两组患者手术时间、术中出血量、术后住院天数、术后胆瘘例数、术后出血例数、术后结石残留及结石复发例数等情况。正态分布的计量资料用均数±标准差(Mean±SD)表示,组间计比较采用t检验。计数资料组间比较采用χ^(2)检验及Fisher精确检验。结果58例患者均完成腹腔镜下手术。左肝外叶切除组手术时间、术中出血量、术后住院天数、术后胆瘘例数、术后出血例数分别为(161.53±30.56)min、(203.45±26.69)mL、(9.26±3.86)d、1例、1例,左半肝切除组分别为(153.16±42.63)min、(198.79±30.82)mL、(9.59±4.01)d、1例、1例,两组相比差异无统计学意义(P>0.05)。左肝外叶切除组术后结石残留和结石复发例数分别为4例、5例,左半肝切除组分别为1例、1例,两者相比差异具有统计学意义(P<0.05)。结论对于特殊部位(影像学上结石位于门静脉左支矢状段和肝左静脉近端附近)的左肝胆管结石,行腹腔下左半肝切除术+胆总管切开取石术是更安全、更有效的治疗方案。

Objective To study the application value of different operation methods in the treatment of left hepatolithiasis in special position (the stone is located in the sagittal section of left portal vein and/or near the proximal end of left hepatic vein).Methods From July 2015 to June 2018,58 patients with left hepatolithiasis in special position in Department of General Surgery,the First People′s Hospital of Tianmen City of Hubei Province were analyzed retrospectively.According to the different operation methods,they were divided into two groups:left liver excision under laparoscopy and gallbladder incision stone group(left liver excision group,n=28)and laparoscopic left-half liver excision and bile tube excision stone removal group(left half liver excision group,n=30).The operation time,intraoperative bleeding,postopera-tive hospital stay,postoperative biliary fistula,postoperative bleeding,postoperative stone residue and stone recurrence were compared between the two groups.The measurement data with normal distributions were represented as(Mean±SD),and comparison between groups was done using the t test.The chi-square test and Fisher precision test were used for comparison between counting data.Results All 58 patients underwent laparoscopic surgery.Left liver excision group surgery time,in-serum bleeding,number of days hospitalized after surgery,number of postoperative bile fistula cases,number of postoperative bleeding cases were(161.53±30.56)min,(203.45±26.69)mL,(9.26±3.3.86)days,1 case,1 case,left half liver excision group(153.16±42.63)min,(198.79±30.82)mL,(9.59±4.01)days 1 case,1 case,The difference between the two groups was not statistically significant(P>0.05).The number of postoperative stone residues was more than that of the left liver and outer leaf excision group(4 cases)than that of the left half of the liver excision group(1 case),and the number of postoperative stone recurrence cases was more than that of the latter(1 case),all of which were statistically significant(P<0.05).The number of stone residues and stone recurrences after left liver excision group was 4 and 5 cases respectively,and the left half liver excision nurses were 1 case and 1 case,respectively,and the difference between the two was statistically significant(P<0.05).Conclusion For the left hepatolithiasis in special position(the stone is located in the sagittal section of the left branch of the portal vein and or near the proximal end of the left hepatic vein in imaging),the lower abdominal left hemihepatectomy+choledocholithotomy is a safer and more effective treatment.