Cai Xiujun, Wang Yifan, Yu Hong, Liang Xiao, Peng Shuyou
Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No. 3, East Qinchun Road, Hangzhou, 310016, China.
Surg Endosc. 2007 Jul;21(7):1074-8. doi: 10.1007/s00464-007-9306-9. Epub 2007 May 22.
Hepatolithiasis is a prevalent disease in Southeast Asia. Hepatectomy was considered the best treatment for majority of cases. Laparoscopic hepatectomy is a new procedure for liver lesions that uses a minimal invasive approach. The aim of this study was to evaluate the feasibility and safety of laparoscopic hepatectomy for hepatolithiasis by comparing it with open hepatectomy.
From November 2002 to March 2006 a total of 30 consecutive patients underwent laparoscopic hepatectomy for hepatolithiasis in Sir Run Run Shaw Hospital. Twenty-nine were included in this study (a converted case was excluded) and called the laparoscopic hepatectomy group (LH). During the same period 22 patients with hepatolithiasis who met the inclusion criteria for laparoscopic hepatectomy were selected for open hepatectomy and called the open group (OH). All operations were performed by the authors. There was no significant difference in preoperative data between the two groups. Data were statistically compared.
Compared with open hepatectomy, those who underwent laparoscopic hepatectomy had a shorter postoperative hospital stay and fasting time, a lower postoperative serum aminotransferase level, and a higher postoperative serum albumin level. Stone clearance rate (intermediate rate, 89.7% vs. 86.4%; final rate, 100% vs. 96.5%), stone recurrence rate (0% vs. 4.5%), operating time, and intraoperative blood loss were similar for the two groups. Six complications occurred, two (6.8%) in LH and four (18.2%) in OH. There was no perioperative mortality in either group.
Laparoscopic hepatectomy for hepatolithiasis is feasible and safe in selected patients.
肝内胆管结石是东南亚地区的一种常见疾病。肝切除术被认为是大多数病例的最佳治疗方法。腹腔镜肝切除术是一种用于肝脏病变的新手术，采用微创方法。本研究的目的是通过与开放性肝切除术比较，评估腹腔镜肝切除术治疗肝内胆管结石的可行性和安全性。
2002年11月至2006年3月，共有30例连续患者在邵逸夫医院接受了腹腔镜肝切除术治疗肝内胆管结石。本研究纳入了29例（排除1例中转病例），称为腹腔镜肝切除术组（LH）。同期，选择22例符合腹腔镜肝切除术纳入标准的肝内胆管结石患者进行开放性肝切除术，称为开放手术组（OH）。所有手术均由作者完成。两组术前数据无显著差异。对数据进行统计学比较。
与开放性肝切除术相比，接受腹腔镜肝切除术的患者术后住院时间和禁食时间更短，术后血清转氨酶水平更低，术后血清白蛋白水平更高。两组的结石清除率（中期清除率，89.7%对86.4%；最终清除率，100%对96.5%）、结石复发率（0%对4.5%）、手术时间和术中出血量相似。发生了6例并发症，腹腔镜肝切除术组2例（6.8%），开放手术组4例（18.2%）。两组均无围手术期死亡。
对于选定的患者，腹腔镜肝切除术治疗肝内胆管结石是可行和安全的。
