腹腔镜与开腹左侧肝切除术治疗肝胆管结石疗效的倾向性评分匹配比较

Propensity score matching comparison of laparoscopic versus open left-sided hepatectomy for hepatolithiasis

背景与目的:肝切除术是治疗肝胆管结石的主要手段之一。然而,腹腔镜左侧肝切除术(LLH)是否优于开腹左侧肝切除术(OLH)仍有争议。因此,本研究通过倾向性评分匹配法(PSM)比较LLH和OLH治疗肝胆管结石的临床疗效。方法:回顾性分析南昌大学第一附属医院2016年1月-2021年7月331例施行左侧肝切除术(包括左肝外叶切除术和左半肝切除术)的肝胆管结石患者的临床资料。使用PSM法对腹腔镜手术患者(LLH组)与开腹手术患者(OLH组)进行1∶1匹配,比较匹配后两组的相关临床指标。结果:PSM后,两组患者共124对匹配成功。与OLH组比较,LLH组的术中出血量(230.6 mL vs. 326.5 mL)、总体并发症发生率(9.7%vs. 23.4%)明显降低,恢复进食时间(1.9 d vs. 2.6 d)、下床活动时间(1.7 d vs.2.3 d)、术后住院时间(8.8 d vs. 10.2d)明显缩短,住院总费用(4.3万元vs. 5.7万元)明显减少(均P<0.05)。两组的手术时间、术中输血例数、胆总管结石取石方式、结石清除率和结石复发率差异均无统计学意义(均P>0.05)。两组均无再次手术和围手术期死亡。LLH组中转开腹率为4.0%。结论:与OLH相比,LLH可减少术中出血量,降低围手术期并发症发生率,节省住院总费用,是治疗左肝内胆管结石安全有效的手术方式。

Background and Aims:Hepatectomy is one of the main treatment methods for hepatolithiasis.However,the advantages of laparoscopic left-sided hepatectomy(LLH) over open left-sided hepatectomy(OLH) are still controversial.Therefore,this study was performed to compare the clinical efficacy of LLH and OLH in the treatment of hepatolithiasis using propensity score matching method.Methods:The clinical data of 331 patients with hepatolithiasis who underwent left hepatectomy (including left lateral hepatectomy and left hemihepatectomy) in the First Affiliated Hospital of Nanchang University from January 2016 to July 2021 were retrospectively analyzed.The patients undergoing laparoscopic surgery(LLH group) and open surgery(OLH group) were matched by PSM at a1:1 ratio.Main clinical variables were compared between the two groups after match.Results:A total of 124 pairs of patients in the two groups were successfully matched after PSM.In LLH group compared with OLH group,the intraoperative blood loss(230.6 m L vs.326.5 m L) and the overall incidence of complications(9.7% vs.23.4%) were significantly decreased,and the time to restore food intake(1.9 d vs.2.6 d),the time to regain ambulation(1.7 d vs.2.3 d),the length of postoperative hospitalization(8.8 d vs.10.2 d) and the total hospitalization cost(43 200 yuan vs.57 000 yuan) were significantly reduced(all P<0.05).There were no significant differences in operative time,number of cases requiring intraoperative blood transfusion,method for common bile duct stone extraction,stone clearance rate,and stone recurrence rate between the two groups(all P>0.05).There was no reoperation and perioperative death in both groups.The open conversion rate in LLH group was 4.0%.Conclusion:LLH is a safe and effective treatment for patients with left-sided hepatolithiasis,and it is superior to OLH in terms of intraoperative blood loss,overall complication,and hospitalization cost.