腹腔镜与开腹左半肝切除术治疗肝内胆管结石的比较。
Laparoscopic vs open left hepatectomy for hepatolithiasis.
机构信息
Department of Laparoscopic Surgery, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China.
出版信息
World J Gastroenterol. 2010 Jun 14;16(22):2818-23. doi: 10.3748/wjg.v16.i22.2818.
AIM
To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis.
METHODS
From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met the inclusion criteria for LLH were treated in our institute. Of the 61 patients with hepatolithiasis, 28 underwent LLH (LLH group) and 33 underwent open left hepatectomy (OLH group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, postoperative hospital stay time, stone clearance and recurrence rate were retrospectively analyzed and compared between the two groups.
RESULTS
LLH was successfully performed in 28 patients. The operation time of LLH group was longer than that of OLH group (158 +/- 43 min vs 132 +/- 39 min, P < 0.05) and the hospital stay time of LLH group was shorter than that of OLH group (6.8 +/- 2.8 d vs 10.2 +/- 3.4 d, P < 0.01). No difference was found in intraoperative blood loss (180 +/- 56 mL vs 184 +/- 50 mL), postoperative complication rate (14.2% vs 15.2%), and stone residual rate (intermediate rate 17.9% vs 12.1% and final rate 0% vs 0%) between the two groups. No perioperative death occurred in either group. Fifty-seven patients (93.4%) were followed up for 2-40 mo (mean 17 mo), including 27 in LLH group and 30 in OLH group. Stone recurrence occurred in 1 patient of each group.
CONCLUSION
LLH for hepatolithiasis is feasible and safe in selected patients with an equal therapeutic effect to that of traditional open hepatectomy.
目的
探讨全腹腔镜左半肝切除术（LLH）治疗肝内胆管结石的可行性和疗效。
方法
自 2006 年 6 月至 2009 年 10 月，我院对符合 LLH 适应证的 61 例肝内胆管结石患者进行了治疗。61 例肝内胆管结石患者中，28 例行 LLH（LLH 组），33 例行开腹左半肝切除术（OLH 组）。回顾性分析比较两组患者的手术时间、术中出血量、术后并发症发生率、术后住院时间、结石清除率及复发率。
结果
28 例患者成功完成 LLH。LLH 组手术时间长于 OLH 组（158 ± 43 min 比 132 ± 39 min，P < 0.05），LLH 组住院时间短于 OLH 组（6.8 ± 2.8 d 比 10.2 ± 3.4 d，P < 0.01）。两组术中出血量（180 ± 56 mL 比 184 ± 50 mL）、术后并发症发生率（14.2%比 15.2%）、结石残留率（中量残留率 17.9%比 12.1%，最终无残留率 0%比 0%）差异无统计学意义。两组均无围手术期死亡病例。57 例（93.4%）获 2~40 个月（平均 17 个月）随访，其中 LLH 组 27 例，OLH 组 30 例。两组各有 1 例结石复发。
结论
在选择的患者中，LLH 治疗肝内胆管结石是可行和安全的，与传统开腹肝切除术疗效相当。
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