摘要
目的 探讨腹腔镜下左肝外叶切除治疗肝胆管结石的临床价值.方法 选取我院2002年11月至2009年10月实施的25例腹腔镜下行左肝外叶切除的肝胆管结石患者作为实验组（腹腔镜组）,同时期39例满足腹腔镜治疗但自愿选择开腹手术的患者作为对照组（开腹组）.观察指标包括手术时间、术中出血量、术后住院天数、术后并发症、术后生化指标（T-BIL、ALT和ALT）及术后住院天数.结果 两组患者在年龄、性别,术前结石类型及生化指标等方面差异无统计学意义（P〉0.05）.腹腔镜组术后有1例并发肝创面胆漏,开腹组切口感染3例,肺部感染1例.与开腹组相比,腹腔镜组术中出血量差异无统计学意义（P=0.075）;腹腔镜组手术时间明显长于开腹组[（270.4±125.9）min与（156.1±76.2）min（P〈0.001）];腹腔镜组与开腹组在术后住院天数[（8.4±2.5）d与（14.0±3.7）d（P〈0.001）]、术后血清T-BIL[（14.1±3.8）IU/L与（16.7±1.5）IU/L（P=0.003）],ALT[（128.1±71.7）IU/L与（185.5±85.9）IU/L（P=0.007）]和AST[（143.2±67.1）IU/L与（187.7±93.3）IU/L（P=0.043）]变化等方面差异有统计学意义.结论 腹腔镜下左肝外叶切除治疗肝胆管结石是一项有前途的微创外科技术,具有创伤小、并发症少、住院时间短、恢复快等优点,值得推广.
Objective To evaluate the safety and feasibility of laparoscopic left hepatectomy for hepatolith. Methods A total of 25 patients with hepatolith who underwent laparoscopic left hemihepatectomy from November 2002 to October 2009 were enrolled in the study as treatment group. Another 39 patients who underwent conventional open left hemihepateetomy served as control. The operative time,intr- aoperative blood loss, duration of hospitalization, postoperative complications, postoperative ALT and AST levels were measured and compared. Results There is no significant difference between the treatment group and the control group for patients＇characteristies. Out of the 25 patients, 1 developed bile leakage in the treatment group,while 3 incisional wound infections and 1 pulmonary infection were found in the control group. Intraoperative blood loss was similar for the two groups（ P = 0.075 ）. The duration of hospitalization was shorter in the treatment group than in the control group （ 8.4 ± 2.5 d vs 14.0 ± 3.7 d, P 〈 0. 001 ）. The operative time in the treatment group was significantly longer than that in the control group （ 270.4 ±125.9 rain vs 156.1 ± 76.2 min, P 〈 0. 001 ）. The levels of T - BIL, ALT and AST were significantly lower in the treatment group than those in the control group （T - BIL, 14.1 ± 3.8 IU/L vs 16.7 ± 1. 5 IU/L,P=0.003; ALT,128.1±71.7 IU/L vs 185.5 ±85.9 IU/L,P=0. 007;AST,143.2±67.1 IU/ L vs 187.7 ± 93.3 IU/L, P = 0. 043 ）. Conclusion Laparoscopic left henfihepatectomy is a safe and feasible procedure for selected hepatolith patients.
出处
《临床外科杂志》
2010年第11期754-756,共3页
Journal of Clinical Surgery
基金
国家自然科学基金资助项目（NO：30600176
30700811）
国家留学基金委资助（NO：2009659015）
