完全腹腔镜下左肝蒂阻断行左半肝切除术治疗肝内外胆管结石

发布时间：2018-07-09 09:29

  本文选题：胆结石 + 肝切除术　； 参考：《中国普通外科杂志》2016年08期

【摘要】：目的:探讨应用左肝蒂阻断法行完全腹腔镜左半肝切除术治疗肝内外胆管结石的可行性、安全性和有效性。方法:回顾性分析2010年月9月—2015年12月间行手术治疗(左半肝切除术、胆囊切除术、胆总管切开探查、胆道镜探查取石、T管引流)的32例肝内外胆管结石患者资料,其中18例患者应用左肝蒂阻断法行完全腹腔镜下手术(腹腔镜组),14例患者采用传统开腹手术(开腹组)。比较两组患者的相关临床指标。结果:两组患者术前资料具有可比性。所有患者均顺利完成手术,腹腔镜组无中转开腹手术。与开腹组比较,腹腔镜组的手术时间延长(273.0 min vs.214.0 min,P0.05),手术费用增加(5 550.0元vs.3 962.0元,P0.05),但术后丙氨酸转氨酶水平(术后1 d:158.2 U/L vs.291.5 U/L;术后7 d:33.3 U/L vs.52.2 U/L)、疼痛缓解时间(3.2 h vs.5.0 h)、术后排气时间(23.3 h vs.45.5 h)、术后住院时间(12.0 d vs.15.7 d)方面均有明显优势(均P0.05);两组术中出血量(226.7 m L vs.189.3 m L)、住院总费用(41 304.4元vs.41 399.8元)、总并发症发生率(11.2%vs.21.3%)差异无统计学意义(均P0.05);两组术后均无结石残留。结论:完全腹腔镜下左肝蒂阻断行左半肝切除术治疗肝内外胆管结石安全、可行、有效,虽然手术时间稍长,但具有创伤小、疼痛轻、恢复快、住院时间短等优势,是一种值得推广的微创手术。
[Abstract]:Objective: to investigate the feasibility, safety and efficacy of laparoscopic left hemihepatectomy with left hepatic pedicle occlusion in the treatment of intrahepatic and extrahepatic cholelithiasis. Methods: the data of 32 patients with intrahepatic and extrahepatic cholelithiasis underwent surgical treatment (left hemihepatectomy, cholecystectomy, choledocholithotomy, choledochoscopy) from September 2010 to December 2015 were retrospectively analyzed. Among them, 18 patients underwent complete laparoscopic surgery (laparoscopic group) with left hepatic pedicle occlusion. 14 patients underwent traditional open operation (open group). To compare the related clinical indexes between the two groups. Results: the preoperative data of the two groups were comparable. All the patients completed the operation successfully, and there was no conversion to open surgery in the laparoscopic group. Compared with the open group, In the laparoscopy group, the operation time was prolonged (273.0 min vs.214.0 / min P0.05), and the operation cost was increased (5 550.0 yuan vs.3 962.0 Yuan / U0.05), but the postoperative alanine aminotransferase level (1: 158.2 U / L vs.291.5 / UL; 7 d / 33.3 U / L vs.52.2 / ul / L), pain relief time (3.2h vs.5.0 h), postoperative time) There was no significant difference in intraoperative blood loss (226.7 mL vs.189.3 mL), total hospitalization cost (41 304.4 yuan vs.41 399.8 yuan) and total complication rate (11.2vs.21.3%) between the two groups (P0.05). There was no residual stone after operation in group A. Conclusion: left hemihepatectomy with complete laparoscopic left hepatic pedicle occlusion is safe, feasible and effective in the treatment of intrahepatic and extrahepatic cholelithiasis. Although the operative time is longer, it has the advantages of small trauma, mild pain, quick recovery and short hospital stay. It is a minimally invasive operation worth popularizing.
【作者单位】： 郑州大学第一附属医院腹腔镜外科;
【分类号】：R657.42
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本文编号：2108920