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腹腔镜下左肝外叶切除术治疗肝内胆管结石的临床效果
Clinical effect of laparoscopic left lateral hepatectomy in treatment of intrahepatic bile duct stones
文章发布日期:2017年07月07日  来源:  作者:凌新建,汪东树  点击次数:324次  下载次数:35次

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【摘要】:目的 探讨腹腔镜下左肝外叶切除术治疗肝内胆管结石的手术方法、安全性及临床疗效。方法 选取安徽医科大学附属安庆医院2015年1月-2016年12月收治的肝内胆管结石患者30例,按照手术方式不同分为常规组(n=15)和腹腔镜组(n=15),常规组采用开腹左肝外叶切除术治疗,腹腔镜组采用腹腔镜下微创左肝外叶切除术治疗,观察两组患者各项手术指标情况,比较两组患者术后并发症情况及术后肝功能指标情况。正态分布的计量资料组间比较采用t检验;非正态分布的计量资料组间比较采用Wilcoxon秩和检验。计数资料组间比较采用χ2检验。结果 腹腔镜组患者的肛门排气时间、术后住院时间较常规组明显缩短[(1.02±0.51) d vs (1.98±0.36) d,t=5.956,P<0.001;(8.83±0.81) d vs (11.83±0.42) d,t=5.830,P<0.001]。腹腔镜组患者术后第5天的ALT水平较常规组降低[(125.8±91.9) U/L vs (214.1±99.6) U/L],血清Alb水平较常规组升高[(33.2±3.7) g/L vs (28.9±4.3) g/L],差异均有统计学意义(t值分别为2.52、2.94,P值分别为0.02、0.01)。结论 临床中应用腹腔镜下左肝外叶切除术治疗肝内胆管结石,相对常规开腹手术治疗,具有手术创伤小、患者术后恢复快、肝功能损伤小等特点,疗效显著,值得临床推广。
【Abstract】:Objective To investigate the surgical method, safety, and clinical effect of laparoscopic left lateral hepatectomy in the treatment of intrahepatic bile duct stones. Methods A total of 30 patients with intrahepatic bile duct stones who were admitted to our hospital from January 2015 to December 2016 were enrolled, and according to the surgical procedure, these patients were divided into conventional group (15 patients) and laparoscopic group (15 patients). The patients in the conventional group were treated with open left lateral hepatectomy, and those in the laparoscopic group were treated with minimally invasive laparoscopic left lateral hepatectomy. Surgical indices were observed, and postoperative complications and liver function parameters were compared between the two groups. The t-test was used for comparison of normally distributed continuous data, and the Wilcoxon rank sum test was used for comparison of non-normally distributed continuous data. The chi-square test was used for comparison of categorical data. Results The laparoscopic group had significant reductions in the time to passage of gas by anus (1.02±0.51 d vs 1.98±0.36 d, t=5.956, P<0.001) and length of postoperative hospital stay (883±0.81 d vs 11.83±0.42 d, t=5.830, P<0.001) compared with the conventional group. Compared with the conventional group, the laparoscopic group had a significantly lower alanine aminotransferase level (125.8±91.9 U/L vs 214.1±99.6 U/L, t=2.52, P=0.02) and a significantly higher serum albumin level (33.2±3.7 g/L vs 28.9±4.3 g/L, t=2.94, P=0.01) at 5 days after surgery. Conclusion Compared with conventional open surgery, laparoscopic left lateral hepatectomy has the features of little trauma, rapid postoperative recovery, and little influence on liver function in the treatment of intrahepatic bile duct stones and has a marked clinical effect. Therefore, it holds promise for clinical application.
【关键字】:胆结石;胆管,肝内;腹腔镜检查;外科手术;治疗
【Key words】:cholelithiasis; bile ducts, intrahepatic; laparoscopy; surgical procedures, operative; therapy
【引证本文】:凌新建, 汪东树. 腹腔镜下左肝外叶切除术治疗肝内胆管结石的临床效果[J]. 临床肝胆病杂志, 2017, 33(8): 1506-1509.

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