摘要
目的比较开腹和腹腔镜肝切除术治疗肝左叶胆管结石的早期及远期临床效果。方法回顾性分析2014年10月至2019年10月安徽医科大学第二附属医院肝胆胰外科实施的开腹和腹腔镜肝左叶切除术治疗的187例肝左叶胆管结石患者的临床资料。使用倾向性评分匹配法(PSM)对开腹肝左叶切除(OLH)组和腹腔镜肝左叶切除(LLH)组患者进行1∶1匹配,两组各47例,年龄分别为(54.7±12.3)岁(范围:34~75岁)和(53.2±12.6)岁(范围:34~75岁)。主要观察指标:手术时间、术中出血量、术后住院时间、并发症发生率、胆瘘发生率、结石清除率及结石复发率等。计量资料的比较采用t检验或秩和检验,计数资料的比较采用χ^2检验或Fisher确切概率法。结果OLH组术后住院时间为(10.8±3.1)d,高于LLH组的(8.5±2.2)d,差异有统计学意义(t=4.085,P=0.000)。OLH组术后胆瘘发生率为21.2%,高于LLH组的6.3%,差异有统计学意义(χ^2=4.374,P=0.036)。OLH组术后并发症发生率为48.9%,高于LLH组的27.6%,差异有统计学意义(χ^2=4.502,P=0.034)。OLH组的结石复发率为17.0%,高于LLH组的4.2%,差异有统计学意义(χ^2=4.029,P=0.045)。多因素分析结果显示,开腹手术(95%CI:1.55~10.75,P=0.004)和并发症(95%CI:1.29~9.52,P=0.013)是延长术后住院时间的独立预后因素;开腹手术(95%CI:1.428~44.080,P=0.018)和结石残留(95%CI:1.580~62.379,P=0.014)是术后胆瘘的独立预后因素;胆瘘(95%CI:1.078~24.517,P=0.040)是结石复发的独立预后因素。结论与开腹肝切除术相比,腹腔镜肝左叶切除术可缩短术后住院时间,降低胆瘘发生率,降低结石复发风险,是治疗肝左叶胆管结石安全、有效的手术方式。
To compare short-term and long-term efficacy after laparoscopic left hepatectomy(LLR)to open left hepatectomy(OLH)for primary left-sided hepatolithiasis.Methods Clinical data of 187 patients with left-sided hepatolithiasis and underwent laparoscopically or open left-sided hepatectomy from October 2014 to October 2019 at the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed in this propensity score matching(PSM)study and were matched in terms of age,sex,body mass index,liver function,ASA score,comorbidities,history of biliary surgery,and smoking history on the ratio of 1∶1.There were 47 cases in each group and the mean age were(54.7±12.3)years old(range:34 to 75 years old)and(53.2±12.6)years old(range:34 to 75 years old)in open and laparoscopically group respectively.The data of operation time,intraoperative blood loss,postoperative hospital-stay,complication rate,biliary fistula rate,stone clearance rate,and stone recurrence rate were compared.The quantitative data were compared using t-test or rank-sum test.Count data were analyzed withχ^2 test or Fisher test.Results No significant difference was observed in the clinical characteristics of included 94 patients in this study(all P>0.05).The length of the postoperative hospital-stay after OLH was significantly higher than that in the LLH group((10.8±3.1)days vs.(8.5±2.2)days,t=4.085,P=0.000).LLR significantly decreased the incidence of postoperative biliary fistula compared with the OLH(6.3%vs.21.2%,χ^2=4.374,P=0.036)and the rates of postoperative complications in the OLH group was significantly higher than that in the LLH group(48.9%vs.27.6%,χ^2=4.502,P=0.034).Moreover,the stone recurrence rates in the LLH group was significantly lower than that after OLR(4.2%vs.17.0%,χ^2=4.029,P=0.045).OLH(95%CI:1.55 to 10.75,P=0.004)and postoperative complications(95%CI:1.29 to 9.52,P=0.013)were independent risk factors for prolonged hospital stay.OLH(95%CI:1.428 to 44.080,P=0.018)and residual stones(95%CI:1.580 to 62.379,P=0.014)wer
作者
潘树波
吴春利
侯辉
周大臣
崔笑
贺良
顾炯
汪雷
喻宗繁
董桂银
谢胜学
熊奇如
耿小平
Pan Shubo;Wu Chunli;Hou Hui;Zhou Dachen;Cui Xiao;He Liang;Gu Jiong;Wang Lei;Yu Zongfan;Dong Guiyin;Xie Shengxue;Xiong Qiru;Geng Xiaoping(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Anhui Medical University,Hefei 230601,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2020年第7期530-538,共9页
Chinese Journal of Surgery
关键词
结石
肝切除术
肝胆管结石
腹腔镜
胆瘘
倾向性评分匹配
Calculi
Hepatectomy
Hepatolithiasis
Laparoscopy
Biliary fistula
Propensity score matching
