Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China.
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, 330006, China.
Int J Surg. 2017 Apr;40:117-123. doi: 10.1016/j.ijsu.2017.02.068. Epub 2017 Feb 28.
Hepatolithiasis is a prevalent disease in some regions of China. Left-sided hepatectomy is an effective treatment for left intrahepatic bile duct stones with irreversible disease, such as biliary strictures, severe parenchymal fibrosis or atrophy. However, the advantages of laparoscopic left-sided hepatectomy (LLH) over open approach (OLH) are still controversial. The aim of this study was to compare the clinical outcomes of LLH to those of OLH in the treatment of hepatolithiasis.
Between January 2013 and October 2016, 75 consecutive patients with hepatolithiasis undergoing left-sided hepatectomy were enrolled in this study. The demographic, intraoperative, and postoperative data were retrospectively analyzed.
Among these 75 patients, 36 underwent LLH (LLH group) and 39 underwent OLH (OLH group). The LLH group exhibited a lower intraoperative blood loss (215.8 ± 75.8 vs 298.7 ± 158.9 mL, p = 0.005), intraoperative transfusion (5.6% vs 23.1%, p = 0.032), overall complication rate (13.9% vs 35.9%, p = 0.029), and shorter recovery of bowel movement (2.3 ± 0.8 vs 3.0 ± 1.0 d, p = 0.004), time of off-bed activities (3.2 ± 1.1 vs 5.8 ± 1.4 d, p < 0.001) and postoperative hospital stay (7.7 ± 2.2 vs 10.9 ± 3.3 d, p < 0.001) compared to the OLH group. Similar results were also observed in left lateral sectionectomy and hemihepatectomy subgroups. There was no significant difference in the operative time, initial stone clearance rate, final stone clearance rate, stone recurrence rate and overall cost (All p > 0.05). No perioperative mortality was observed. The conversion rate was 5.6%.
LLH is a safe and effective treatment for selected patients with hepatolithiasis, with an advantage over OLH in the field of intraoperative blood loss, intraoperative transfusion, overall complication and postoperative recovery.
肝内胆管结石病是中国部分地区的一种常见病。对于不可逆病变如胆管狭窄、严重肝实质纤维化或萎缩等左肝内胆管结石，左半肝切除术是一种有效的治疗方法。然而，腹腔镜左半肝切除术（LLH）相对于开腹手术（OLH）的优势仍存在争议。本研究旨在比较 LLH 与 OLH 治疗肝内胆管结石的临床疗效。
回顾性分析 2013 年 1 月至 2016 年 10 月间收治的 75 例行左半肝切除术的肝内胆管结石患者的临床资料。
75 例患者中，36 例行 LLH（LLH 组），39 例行 OLH（OLH 组）。LLH 组术中出血量（215.8±75.8 比 298.7±158.9，p=0.005）、术中输血率（5.6%比 23.1%，p=0.032）、总并发症发生率（13.9%比 35.9%，p=0.029）、术后排气时间（2.3±0.8 比 3.0±1.0，p=0.004）、下床活动时间（3.2±1.1 比 5.8±1.4，p<0.001）和术后住院时间（7.7±2.2 比 10.9±3.3，p<0.001）均低于 OLH 组。在左外叶切除术和半肝切除术亚组中也观察到了相似的结果。两组手术时间、结石初始清除率、结石最终清除率、结石复发率和总费用差异均无统计学意义（均 P>0.05）。两组均无围手术期死亡病例。中转开腹率为 5.6%。
对于选择性的肝内胆管结石患者，LLH 是一种安全有效的治疗方法，在术中出血量、术中输血、总体并发症和术后恢复方面优于 OLH。
