Institute of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gaotanyan Main Street, Shapingba District, Chongqing, 400038, China.
Surg Endosc. 2019 Aug;33(8):2539-2547. doi: 10.1007/s00464-018-6547-8. Epub 2018 Oct 22.
The indication for laparoscopic treatment of hepatolithiasis is early-stage regional hepatolithiasis. Open surgery (OS) is the traditional treatment for complex hepatolithiasis. Robotic-assisted laparoscopic surgery (RLS) overcomes the limitations of the traditional laparoscopic approach in terms of the visual field, instruments, and operational flexibility. RLS is thus theoretically indicated for the treatment of complicated hepatolithiasis. This study aimed to evaluate the safety, efficacy, and feasibility of RLS for the treatment of complicated hepatolithiasis.
From October 2010 to August 2017, 26 consecutive patients who underwent RLS and 287 consecutive patients who underwent OS for the treatment of complicated hepatolithiasis at our center were included in this study. We performed a propensity score matching (PSM) analysis between patients who underwent RLS and patients who underwent OS at a ratio of 1:2. Twenty-six patients were included in the RLS group, and 52 patients were included in the OS group.
The groups exhibited no differences with respect to age, sex, location of stones, liver function, history of previous surgery, or Child-Pugh classification. There were no differences in the postoperative complication rates (46.2% vs. 63.5%, p = 0.145), intraoperative stone clearance rates (96.2% vs. 90.4%, p = 1.000), or final stone clearance rates (100% vs. 98.1%, p = 0.652) between the two groups. The RLS group had less blood loss (315.38 ± 237.81 vs. 542.88 ± 518.70 ml, p = 0.037), a lower transfusion rate (15.4% vs. 46.2%, p = 0.008), shorter oral intake times (3.50 ± 1.30 vs. 5.88 ± 4.00 days, p = 0.004), and shorter postoperative hospital stays (13.54 ± 6.54 vs. 17.81 ± 7.49 days, p = 0.016) than the OS group. At a median follow-up of 48 months (range 7-90 months), there were no differences in stone recurrence rate (3.8% vs. 13.5%, p = 0.356) or recurrent cholangitis rate (3.8% vs. 3.8%, p = 1.000) between RLS and OS patients.
RLS for complicated hepatolithiasis is safe and feasible with advantages over OS in terms of intraoperative blood loss, transfusion rate, duration of hospital stays, and postoperative recovery.
腹腔镜治疗肝内胆管结石的适应证为早期区域性肝内胆管结石。开放性手术（OS）是复杂肝内胆管结石的传统治疗方法。机器人辅助腹腔镜手术（RLS）克服了传统腹腔镜手术在视野、器械和操作灵活性方面的局限性。因此，RLS 理论上适用于治疗复杂的肝内胆管结石。本研究旨在评估 RLS 治疗复杂肝内胆管结石的安全性、疗效和可行性。
本研究纳入了 2010 年 10 月至 2017 年 8 月期间在我院接受 RLS 和 OS 治疗的 26 例复杂肝内胆管结石患者和 287 例复杂肝内胆管结石患者。我们采用倾向评分匹配（PSM）方法，以 1:2 的比例将接受 RLS 治疗的患者与接受 OS 治疗的患者进行匹配。26 例患者纳入 RLS 组，52 例患者纳入 OS 组。
两组患者的年龄、性别、结石位置、肝功能、既往手术史或 Child-Pugh 分级无差异。两组患者的术后并发症发生率（46.2%比 63.5%，p=0.145）、术中结石清除率（96.2%比 90.4%，p=1.000）和最终结石清除率（100%比 98.1%，p=0.652）无差异。RLS 组的出血量（315.38±237.81 比 542.88±518.70 ml，p=0.037）、输血率（15.4%比 46.2%，p=0.008）、口服进食时间（3.50±1.30 比 5.88±4.00 天，p=0.004）和术后住院时间（13.54±6.54 比 17.81±7.49 天，p=0.016）均低于 OS 组。中位随访时间为 48 个月（7-90 个月），RLS 组和 OS 组的结石复发率（3.8%比 13.5%，p=0.356）和复发性胆管炎率（3.8%比 3.8%，p=1.000）无差异。
RLS 治疗复杂肝内胆管结石是安全可行的，与 OS 相比，RLS 在术中出血量、输血率、住院时间和术后恢复方面具有优势。
