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腹腔镜肝切除术联合胆管探查术治疗肝胆管结石: 116 例经验。

Laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis: an experience of 116 cases.

机构信息

Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Shapingba District, Chongqing, People's Republic of China.

出版信息

Dig Liver Dis. 2013 Jun;45(6):493-8. doi: 10.1016/j.dld.2013.01.003. Epub 2013 Feb 8.

Abstract

BACKGROUND

An increasing number of patients with hepatolithiasis were diagnosed at an early stage in China. Laparoscopic surgery has introduced new methods of treating this condition.

AIM

To investigate the patient selection, operative technique, and efficacy of laparoscopic hepatectomy with bile duct exploration for the treatment of hepatolithiasis.

PATIENTS AND METHODS

The clinical data of 116 patients who underwent laparoscopic hepatectomy (laparoscopic group) and 78 patients who underwent open hepatectomy (open group) for hepatolithiasis were retrospectively analyzed, and were compared with the recent reports.

RESULTS

The laparoscopic group had a longer duration of operation (323.3 ± 103.0 min vs. 272.8 ± 66.8 min, p<0.05) and shorter postoperative hospital stay (13.1 ± 5.6 days vs. 16.5 ± 8.4 days, p<0.05) than the open group. There were no significant differences between the two groups in intraoperative blood loss or transfusion rate, postoperative complications, calculus clearance, calculus recurrence, or recurrent cholangitis (p>0.05 for all). Efficacy in the laparoscopic group was similar to that in other recently reported studies.

CONCLUSIONS

Laparoscopic hepatectomy with bile duct exploration is safe and feasible for early stage localized hepatolithiasis, with an efficacy similar to that of open surgery. Anatomic hepatectomy is important for achieving good therapeutic outcomes.

摘要

背景

在中国,越来越多的肝内胆管结石患者在早期被诊断出来。腹腔镜手术为治疗这种疾病带来了新的方法。

目的

探讨腹腔镜肝切除术联合胆管探查术治疗肝内胆管结石的患者选择、手术技术和疗效。

患者和方法

回顾性分析了 116 例行腹腔镜肝切除术(腹腔镜组)和 78 例行开腹肝切除术(开腹组)治疗肝内胆管结石的患者的临床资料,并与近期的报告进行了比较。

结果

腹腔镜组的手术时间(323.3±103.0 min 比 272.8±66.8 min,p<0.05)和术后住院时间(13.1±5.6 天比 16.5±8.4 天,p<0.05)均长于开腹组。两组术中出血量和输血率、术后并发症、结石清除率、结石复发率和复发性胆管炎的发生率无显著差异(p>0.05)。腹腔镜组的疗效与其他近期报道的研究相似。

结论

腹腔镜肝切除术联合胆管探查术治疗早期局限性肝内胆管结石是安全可行的,疗效与开腹手术相似。解剖性肝切除术对获得良好的治疗效果很重要。

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