Huang X J, He Y, He L, Feng Y J, Yang G, Xiong Y F, Li J D
The First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Institute of Hepato-Biliary-Pancreatic-Intestinal Disease,North Sichuan Medical College,Nanchong 637000, China.
Zhonghua Wai Ke Za Zhi. 2022 Jun 1;60(6):593-598. doi: 10.3760/cma.j.cn112139-20211212-00594.
To compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis. Between January 2014 and May 2020, the clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy at the First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College were collected retrospectively. There were 74 males and 180 females with age of (56±8) years (range: 38 to 77 years). Of the 254 patients, 162 underwent laparoscopic surgery (laparoscopic group) and 92 underwent open surgery (open group). Propensity score matching(PSM) was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups. The -test, Mann-Whitney test, χ test or Fisher's exact probability method was used to compare the perioperative data and follow-up results of the two groups after matching, respectively. Each group had 63 patients after PSM with well-balanced baseline characteristics. There was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate,intraoperative accidental injury rate,initial and final stone clearance rate,and stone recurrence rate between the two groups. However,compared with the open hepatectomy group, the laparoscopic group had significantly lower intraoperative blood loss ((IQR))(300(175)ml 350(145)ml, =3.227,=0.001),shorter postoperative hospital stay((10.6±4.1)days (14.0±4.0)days,=4.634,0.01),shorter time to postoperative oral intake ((1.8±1.1)days (2.9±1.6)days, =4.556, 0.01), and lower postoperative complication rate (25.4%(16/63) 49.2%(31/63), χ²=7.635, =0.006). Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.
比较腹腔镜肝切除术和开腹肝切除术治疗肝内胆管结石的安全性和疗效。回顾性收集2014年1月至2020年5月在川北医学院附属医院肝胆外科一病区接受腹腔镜或开腹肝切除术的254例肝内胆管结石患者的临床病理资料。其中男性74例，女性180例，年龄（56±8）岁（范围：38至77岁）。254例患者中，162例行腹腔镜手术（腹腔镜组），92例行开腹手术（开腹组）。采用倾向评分匹配（PSM）法对两组的基线特征进行匹配，然后比较两组的围手术期结果和随访疗效。分别采用t检验、Mann-Whitney检验、χ²检验或Fisher确切概率法比较匹配后两组的围手术期数据和随访结果。PSM后每组各有63例患者，基线特征均衡。两组在肝切除术类型、联合胆总管探查率、T管引流放置率、手术时间、术中输血率、术中意外损伤率、初始和最终结石清除率以及结石复发率方面无统计学差异。然而，与开腹肝切除术组相比，腹腔镜组术中出血量（四分位数间距）显著更低（300（175）ml比350（145）ml，Z = 3.227，P = 0.001），术后住院时间更短（（10.6±4.1）天比（14.0±4.0）天，t = 4.634，P = 0.01），术后开始经口进食时间更短（（1.8±1.1）天比（2.9±1.6）天，t = 4.556，P = 0.01），术后并发症发生率更低（25.4%（16/63）比49.2%（31/63），χ² = 7.635，P = 0.006）。腹腔镜肝切除术治疗肝内胆管结石安全有效，具有术中出血少、术后并发症少、术后恢复快等优点。
