腹腔镜与开腹肝切除术治疗肝内胆管结石疗效的比较

发布时间：2018-05-29 01:00

  本文选题：肝内胆管结石 + 腹腔镜肝切除术　； 参考：《山东大学》2017年硕士论文

【摘要】：研究背景:肝内胆管结石是一种临床上常见的复杂疾病,目前规则性的肝叶切除术仍然是其标准外科治疗方式,近年来腹腔镜应用越来越广泛,但其肝胆结石病反复感染导致的腹腔内粘连及解剖变异限制了腹腔镜肝切除术在本病的应用。研究目的:评估比较腹腔镜与开腹肝切除术治疗肝内胆管结石围手术期及临床疗效,分析腹腔镜治疗肝内胆管结石的可行性、有效性及其优势。研究方法:回顾性分析从2012年1月1日至2017年1月1日就诊于山东大学齐鲁医院接受手术治疗的肝内胆管结石病人相关资料,其中22位患者接受腹腔镜肝切除术,包括左半肝切除术(n=7)左外叶切除术(n=14)右半肝切除术(n=1),30位患者接受开腹肝切除术,包括左半肝切除术(n=7)左外叶切除术(n=18)右半肝切除术(n=2)右肝部分切除术(n=3).根据病历资料及随访资料,对两组患者围手术期及临床效果进行比较,包括患者年龄、性别、体质量指数、结石位置、术前白蛋白、术后白蛋白、手术时间、术中失血量、术后输血情况、术后肝功、术后胆红素、术后拔管时间、禁食时间、术后住院时间、住院费用、术后并发症、结石清除率、结石复发率等。应用SPSS 23.0软件对各组数据进行录入及统计分析,计量资料用x±s表示,应用t检验,计数资料用率表示,应用χ 2检验。P值均表示双侧概率,显著性水平α =0.05,以P0.05为差异有统计学意义。结果:满足纳入标准者有52例,腹腔镜组22例,开腹组30例,两组患者年龄(58.64±9.209vs53.60±9.099 岁,p=0.055)、性别(9:13vs9:21 男:女,p=0.414)、BMI(13:9vs18:12,24:≥24,p=0.947)、肝功能(20:2vs27:3,child 分级 A:B,p=0.913)、术前血清白蛋白(42.145±2.900vs39.917±5.993 g\L,p=0.083)等术前一般指标无差异;腹腔镜组相对于开腹组术中出血更少(117.27±67.414vs 269.33±369.771 ml,p=0.035),术后并发症更少(9.1%vs 36.7%,p=0.028),术后禁食时间短(2.77±0.922 vs 3.80± 1.972 天,p=0.016),术后转氨酶水平低(谷丙转氨酶93.95±48.958 vs 201.13± 166.683 IU\L,p=0.002;谷草转氨酶89.50±57.138vs219.70±236.520IU\L,p=0.007),术后血清白蛋白水平高(36.695±4.546 vs 30.703±4.831 g\L,p=0.000),术后引流管拔除时间早(8.59±3.699 vs 16.57±10.523 天,p=0.000),术后住院时间短(11.23±3.308 vs19.80±11.158 天,p=0.024),术后抗生素应用时间短(5.86±2.315 vs 7.93±4.025天,p=0.024),而手术时间(236.36±104.769 vs 264.17±113.624 分钟,p=0.372)、术中输血(4.5%vs 20.0%,p=0.107)、术后总胆红素(20.873±20.697 vs 27.110±18.309 umol\L,p=0.256)、术后三天平均引流量(76.14±74.573 vs 89.87±60.835 ml,p=0.468)、术后输血(9.1%vs 13.3%,p=0.636)、结石清除率(初次手术结石清除率86.4%vs 73.3%,p=0.256;最终结石清除率100%vs 96.7%,p=0.387)、结石复发率(0%vs 6.7%,p=0.502)、治疗费用(48640.45±18879.721 vs 41274.87± 14152.497 元,p=0.114)无明显差异。结论:腹腔镜肝切除术治疗肝内胆管结石安全有效,能够达到与开腹手术一样的疗效,并有术中出血少、术后并发症少、术后禁食时间短、肝功能影响小、术后住院时间短、对患者创伤小等优势,值得临床推广应用。
[Abstract]:Background: intrahepatic cholangiolithiasis is a common and complex disease. Currently, regular lobectomy is still a standard surgical treatment. In recent years, the application of laparoscopy is becoming more and more extensive. However, intraperitoneal adhesion and anatomical variation caused by repeated infection of hepatolithiasis are limited by laparoscopic hepatectomy in this disease. Objective: To evaluate the perioperative and clinical efficacy of laparoscopic and open hepatectomy for intrahepatic bile duct stones, and to analyze the feasibility, effectiveness and advantages of laparoscopy in the treatment of intrahepatic bile duct stones. A retrospective analysis from January 1, 2012 to January 1, 2017 in Qilu Hospital of Shandong University was treated by surgical treatment. 22 patients received laparoscopic hepatectomy, including Zuo Bangan resection (n=7) left lateral lobectomy (n=14) right hemihepatectomy (n=1), and 30 patients received open hepatectomy, including left hemihepatectomy (n=7) left lateral lobectomy (n=18) right hemihepatectomy (n=2) right liver partial resection (n=2). N=3). According to the medical records and follow-up data, the perioperative and clinical effects of the two groups were compared, including patient's age, sex, body mass index, stone position, preoperative albumin, postoperative albumin, operation time, blood loss, postoperative blood transfusion, postoperative liver function, postoperative bilirubin, postoperative extubation time, fasting time, postoperative residence. Hospital time, hospitalization expenses, postoperative complications, stone clearance rate, calculi recurrence rate and so on. SPSS 23 software was used to record and analyze the data of each group. The measurement data were expressed in X + s, t test was used, the use rate of counting data was expressed, and the.P value of the x 2 was used to show bilateral probability, the significant level was alpha =0.05, and the difference of P0.05 was statistically significant Results: there were 52 cases of inclusion criteria, 22 cases in laparoscopy group, 30 cases in open group, two group of patients (58.64 + 9.209vs53.60 + 9.099 years old, p=0.055), sex (9:13vs9:21 male: female, p=0.414), BMI (13:9vs18:12,24: > 24, p=0.947), liver function (20: 2vs27:3, child grade A:B, p=0.913), and preoperative serum albumin (42.145 + + 5.). 993 gL, p=0.083) had no difference before operation, and there were less bleeding in laparoscopy group (117.27 + 67.414vs 269.33 + 369.771 ml, p=0.035), less postoperative complications (9.1%vs 36.7%, p=0.028), short time after operation (2.77 + 0.922 vs 3.80 + 1.972 days, p=0.016), and low level of transaminase after operation (93.95 + 48.95. 8 vs 201.13 + 166.683 IUL, p=0.002, 89.50 + 57.138vs219.70 + 236.520IUL, p=0.007), after operation, the level of serum albumin was high (36.695 + 4.546 vs 30.703 + 4.831 gL, p=0.000), and the drainage time was early (8.59 + 3.699 vs 16.57 + 10.523 days, p= 0). 24) after operation, the time of antibiotic application was short (5.86 + 2.315 vs 7.93 + 4.025 days, p=0.024), and the operation time (236.36 + 104.769 vs 264.17 + 113.624 minutes, p=0.372), intraoperative blood transfusion (4.5%vs 20%, p=0.107), postoperative total bilirubin (20.873 + 20.697 vs 27.110 + umolL, p=0.256). 35 ml, p=0.468), postoperative blood transfusion (9.1%vs 13.3%, p=0.636), stone clearance rate (86.4%vs 73.3%, p=0.256; final stone clearance 100%vs 96.7%, p=0.387), calculi recurrence rate (0%vs 6.7%, p=0.502), treatment cost (48640.45 + 18879.721 vs 41274.87 + 14152.497 yuan, p=0.114) no significant difference. Conclusion: laparoscopic liver Resection of intrahepatic bile duct stones is safe and effective, and can achieve the same effect as open surgery, with less bleeding, less postoperative complications, short post operation time, small effect of liver function, short hospital stay, and small trauma to patients. It is worthy of clinical application.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3

【参考文献】

中国期刊全文数据库 前10条

1 祝伟;张瑞麟;田敏;;胆道镜联合钬激光治疗肝内胆管结石的临床研究[J];中国现代药物应用;2016年22期

2 李乔林;胡从兵;胡剑飞;彭滔;邓黎;;肝内胆管结石手术切口感染的危险因素分析[J];中华医院感染学杂志;2016年09期

3 赵加泉;王亮;吕纯业;;腹腔镜下胆总管切开取石术与开腹手术的临床比较[J];实用临床医药杂志;2015年19期

4 Reiji Sugita;;Pancreaticobiliary reflux as a high-risk factor for biliary malignancy:Clinical features and diagnostic advancements[J];World Journal of Hepatology;2015年13期

5 李幼林;潘江华;窦巩昊;童晓春;尤孙武;;胆胰镜下钬激光碎石术治疗术后难取性胆管结石[J];肝胆胰外科杂志;2015年03期

6 赵坤;叶小鸣;;自噬与肝移植的研究进展[J];器官移植;2015年03期

7 李文锋;;经皮胆管镜治疗肝内外胆管结石的临床价值[J];临床合理用药杂志;2015年03期

8 殷晓煜;;胆道外科手术中Oddi括约肌保护的共识与争议[J];中国实用外科杂志;2015年01期

9 陈平;皮儒先;;肝内胆管结石的外科治疗研究进展[J];中国普外基础与临床杂志;2014年10期

10 董家鸿;曾建平;;胆肠吻合术——从纷繁走向简约[J];中国实用外科杂志;2014年10期

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