基于逆概率加权法分析肝胆管结石病腹腔镜与开放肝切除术的安全性及有效性分析

Analysis of the safety and efficacy of laparoscopic hepatectomy and open hepatectomy for patients with hepatolithiasis based on inverse probability of treatment weighting

目的比较开放肝切除(OH)和腹腔镜肝切除(LH)治疗肝胆管结石病的安全性与有效性,为LH在肝胆管结石病的应用提供询证医学证据。方法纳入2002~2020年西南医院与北京清华长庚医院收治的的肝胆管结石肝切除患者402例。依据手术方式分为OH组331例与LH组71例。通过逆概率加权(IPTW)平衡两组的临床资料,比较两组患者的安全性和有效性。结果IPTW后:LH组的总并发症发生率38.5%,无术后肝衰竭发生,中位术中失血量200 ml;OH组并发症发生率69.4%,术后肝衰竭发生率3.7%,中位术中失血量300 ml,两组比较差异有统计学意义(P<0.05);两组中位无复发生存间隔(mRFI)比较,差异无统计学意义(P>0.05)。结论LH治疗肝胆管结石相对于OH在安全性上具有特定的优势,在有效性上与OH基本相似。

Objective To compare the safety and efficacy between open hepatectomy(OH)and laparoscopic hepatectomy(LH)in the treatment of hepatolithiasis in order to provide evidence-based medical support for the application of LH.Methods Four hundred and two patients who underwent liver resection in our hospitals from 2002 to 2020 were selected.The patients were divided into the OH group(n=331)and the LH group(n=71)according to surgical methods.Inverse probability of treatment weighting(IPTW)was used to balance the clinical data between the two groups.The safety and efficacy were compared between the two groups.Results After IPTW,the overall complication rate of the LH group was 38.5%,that was lower than 69.4%of the OH group(P=0.001).The postoperative liver failure of the LH group was 0.00%,that was lower than 3.7%of the OH group(P=0.001).The intraoperative blood loss of the LH group was 200 ml,that was lower than 300 ml of the OH group(P=0.032).However,there was no significant dfference in median recurrence-free interval(mRFI)between the two groups.Conclusions LH has specific advantages over OH in the treatment of hepatolithiasis in terms of safety.However,LH is basically similar to OH in terms of effectiveness.