腹腔镜免T管左肝外叶切除治疗肝胆管结石临床分析
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摘要
目的探讨腹腔镜免T管左肝外叶切除治疗肝胆管结石的疗效、可行性及安全性。方法将我院2017年1月至2018年8月收治的以左肝外叶结石为主的肝胆管结石患者68例按随机数字法分为经左肝管探查组(LHD组)及经胆总管探查组(CBD组),每组34例。LHD组患者采用腹腔镜左肝外叶切除经左肝管残端置入胆道镜行肝内胆管及胆总管探查取石,缝合左肝管残端,不放置T管。CBD组患者采用腹腔镜左肝外叶切除胆总管切开胆道镜探查取石及T管引流术。分析比较2组患者手术时间、术中出血量、拔管时间、住院时间、术后残石率及并发症等指标。结果 LHD组患者手术时间少于CBD组,差异有统计学意义(P <0. 05)。2组患者术中出血量、拔管时间、住院时间、术后残石率及并发症发生率比较,差异无统计学意义(P> 0. 05)。结论腹腔镜免T管左肝外叶切除治疗以左肝外叶结石为主的肝胆管结石安全可行且有效。
Objective To compare the efficacy,the feasibility and safety of laparoscopic left lateral hepatectomy with T-tube-free and laparoscopic left extrahepatic lobectomy for the treatment of hepatolithiasis. Methods A total of 68 patients who were treated in our hospital from January 2017 to August 2018 were randomly divided into observation group and control group,with 34 cases in each group. The observation group were treated by laparoscopic left extrahepatic lobectomy with choledochoscope palced through the left hepatic duct to explore and remove the stones in the intrahepatic bile duct and common bile duct,and the left hepatic duct stump was sutured without T tube. The control group were treated by laparoscopic left extrahepatic lobectomy with choledochotomy performed to explore the stones and T tube drainage. The operation time,intraoperative blood loss,postoperative extubation time,postoperative hospital stay,postoperative residual stone rate and postoperative complications were analyzed and compared between the two groups. Results The operation time in the observation group were less than that in the control group,the difference was statistically significant( P < 0. 05). There was no statistically significant difference in the amount of blood loss,postoperative tubal extubation time,postoperative hospital stay,postoperative residual stone rate and postoperative complications between two groups( P > 0. 05). Conclusion Laparoscopic left extrahepatic lobectomy with T-tube-free for the treatment of hepatolithiasis mainly caused by left extrahepatic calculi is safe,effective and feasible.
Objective To compare the efficacy,the feasibility and safety of laparoscopic left lateral hepatectomy with T-tube-free and laparoscopic left extrahepatic lobectomy for the treatment of hepatolithiasis. Methods A total of 68 patients who were treated in our hospital from January 2017 to August 2018 were randomly divided into observation group and control group,with 34 cases in each group. The observation group were treated by laparoscopic left extrahepatic lobectomy with choledochoscope palced through the left hepatic duct to explore and remove the stones in the intrahepatic bile duct and common bile duct,and the left hepatic duct stump was sutured without T tube. The control group were treated by laparoscopic left extrahepatic lobectomy with choledochotomy performed to explore the stones and T tube drainage. The operation time,intraoperative blood loss,postoperative extubation time,postoperative hospital stay,postoperative residual stone rate and postoperative complications were analyzed and compared between the two groups. Results The operation time in the observation group were less than that in the control group,the difference was statistically significant( P < 0. 05). There was no statistically significant difference in the amount of blood loss,postoperative tubal extubation time,postoperative hospital stay,postoperative residual stone rate and postoperative complications between two groups( P > 0. 05). Conclusion Laparoscopic left extrahepatic lobectomy with T-tube-free for the treatment of hepatolithiasis mainly caused by left extrahepatic calculi is safe,effective and feasible.
引文
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[18]Dokmak S,Raut V,Aussilhou B,et al.Laparoscppic left lateral resection is the gold standerd for benign liver lesions:a case-control[J].staudy,2014,16(2):183-187.doi:org/10.1111/hpb.12108.
[19]Hu MG,Zhao GD,Ouyang CG,et al.Lithotomy using cholangioscopy via the left hepatic duct orifice versus the common bile duct in laparoscopic treatment of left-sided hepatolithiasis:a comparative study[J].JLaparoendosc Adv Surg Tech A,2013,23(4):332-338.doi:10.1089/lap.2012.0397.
[20]Hwang S,Lee SG,Kim MH,et al.Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis[J].Langenbecks Arch Surg,2008,393(3):383-389.doi:org/10.1007/s00423-007-0200-7.
[2]尹新民,徐威,成伟,等.“两步分层法”腹腔镜肝左外叶切除术的临床应用价值[J].中华肝脏外科手术学电子杂志,2015(6):340-343.doi:10.3877/cma.j.issn.2095-3232.2015.06.004.
[3]Dokmak S,Raut V,Aussilhou B,et al.Laparoscopic left lateral resection is the gold standard for benign liver lesions:a case-control study[J].HPB,2014,16(2):183-187.doi:org/10.1111/hpb.12108.
[4]汤雨,廖永晖,千年松,等.腹腔镜下左肝外叶切除治疗肝胆管结石25例临床分析[J].临床外科杂志,2010,18(11):754-756.doi:10.3969/j.issn.1005-6483.2010.11.017.
[5]Li EL,Yuan RF,Liao WJ,et al.Intrahepatic bile duct exploration lithotomy is a useful adjunctive hepatectomy method for bilateral primary hepatolithiasis:an eight-year experience at a single centre[J].BMCSurg,2019,19(1):16.doi:10.1186/s12893-019-0480-1.
[6]Siming Z,Jie Z,Hong L,et al.Laparoscopic caudate lobe resection for the treatment of hepatolithiasis[J].J Minim Access Surg,2019.doi:10.4103/jmas.JMAS_194_18.
[7]Chen TH,Yang HR,Jeng LB,et al.Laparoscopic liver resection:Experience of 436 cases in one center[J].J Gastrointest Surg,2018.doi:10.1007/s 11605-018-4023-3.
[8]Kitagawa Y,Nimura Y,Hayakawa N,et al.Intrahepatic segmental bile duct patterns in hepatolithiasis:a comparative cholangiographic study between Taiwan and Japan[J].J Hepatobiliary Pancreat Surg,2003,10(5):377-381.doi:org/10.1007/s00534-002-0834-3.
[9]Shu J,Wang XJ,Li JW,et al.Robotic-assisted laparoscopic surgery for complex hepatolithiasis:a propensity score matching analysis[J].Surg Endosc,2018.doi:10.1007/s00464-018-6547-8.
[10]Tanaka Y,Tainaka T,Sumida W,et al.Introduction of resection of intrahepatic bile duct stenosis-causing membrane or septum into laparoscopic choledochal cyst excision[J].Pediatr Surg Int,2018,34(10):1087-1092.doi:10.1007/s00383-018-4320-7.
[11]Peng JX,Wang LZ,Diao JF,et al.Major hepatectomy for primary hepatolithiasis:a comparative study of laparoscopic versus open treatment[J].Surg Endosc,2018,32(10):4271-4276.doi:10.1007/s00464-018-6176-2.
[12]Lei J,Huang J,Yang X,et al.Minimally invasive surgery versus open hepatectomy for hepatolithiasis:A systematic review and meta analysis[J].Int J Surg,2018,51:191-198.doi:10.1016/j.ijsu.2017.12.038.
[13]Chen S,Huang L,Qiu FN,et al.Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis:Apropensity,long-term follow-up analysis at a single center[J].Surgery,2018,163(4):714-720.doi:10.1016/j.surg.2017.10.053.
[14]Ding G,Cai W,Qin M.Pure laparoscopic versus open liver resection in treatment of hepatolithiasis within the left lobes:a randomized trial study[J].Surg Laparosc Endosc Percutan Tech,2015,25(5):392-394.doi:10.1097/SLE.0000000000000120.
[15]Yang T,Lau WY,Lai EC,et al.Hepatectomy for bilateral primary hepatolithiasis:a cohort study[J].Ann Surg,2010,251(1):84-90.doi:org/10.1097/SLA.0b013e3181b2f374.
[16]Ye X,Ni K,Zhou X,et al.Laparoscopic versus open left hemihepatectomy for hepatolithiasis[J].J Surg Res,2015,199(2):402-406.doi:10.1016/j.jss.2015.06.021.
[17]Jin RA,Wang Y,Yu H,et al.Total laparoscopic left hepatectomy for primary hepatolithiasis:Eight-year experience in a single center[J].Surgery,2016,159(3):834-841.doi:10.1016/j.surg.2015.09.022.
[18]Dokmak S,Raut V,Aussilhou B,et al.Laparoscppic left lateral resection is the gold standerd for benign liver lesions:a case-control[J].staudy,2014,16(2):183-187.doi:org/10.1111/hpb.12108.
[19]Hu MG,Zhao GD,Ouyang CG,et al.Lithotomy using cholangioscopy via the left hepatic duct orifice versus the common bile duct in laparoscopic treatment of left-sided hepatolithiasis:a comparative study[J].JLaparoendosc Adv Surg Tech A,2013,23(4):332-338.doi:10.1089/lap.2012.0397.
[20]Hwang S,Lee SG,Kim MH,et al.Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis[J].Langenbecks Arch Surg,2008,393(3):383-389.doi:org/10.1007/s00423-007-0200-7.