摘要
目的探讨腹腔镜肝部分切除术(LPH)与腹腔镜胆总管切开取石术(LCBDE)治疗肝内胆管结石的临床效果。方法回顾性选取2014年4月至2020年3月88例肝内胆管结石患者,根据采取手术方式的不同分为LPH组(n=46例,行LPH)和LCBDE组(n=42例,行LCBDE)。采用SPSS27.0统计学软件处理数据,计量资料均符合正态分布用(±s)表示,组间、组内比较分别用独立样本t、配对样本t检验;计数资料用[例(%)]表示,行χ^(2)检验。P<0.05为差异有统计学意义。结果与LCBDE组比较,LPH组患者手术时间更长、术中出血量更多(P<0.05);两组患者术后1d、3d的丙氨酸氨基转移酶(ALT)、天门冬氨酸转移酶(AST)、γ-谷氨酰转肽酶(γ-GGT)、总胆红素(TBIL)均较术前升高(P<0.05),且LPH组上述指标更高(P<0.05);LPH组与LCBDE组患者术后并发症总发生率无明显差异(P>0.05);与LCBDE组比较,LPH组患者术后结石残余率更低(P<0.05);术后随访36个月,两组患者复发率比较无明显差异(P>0.05)。结论不同的微创手术方式治疗肝内胆管结石均可获得较好的效果,LCBDE在微创方面更具优势,但在降低术中结石残余率方面不及LPH,因此临床上应当根据患者实际情况,选择个性化的治疗方案。
Objective To explore the clinical effects of laparoscopic partial hepatectomy(LPH)and laparoscopic common bile duct exploration and stone removal(LCBDE)in the treatment of intrahepatic cholangiolithiasis.Methods A total of 88 patients with intrahepatic cholangiolithiasis from April 2014 to March 2020 were retrospectively selected.According to the different surgical methods,they were divided into the LPH group(n=46 cases,undergoing LPH)and the LCBDE group(n=42 cases,undergoing LCBDE).The SPSS27.0 statistical software was used to process the data.Measurement data conforming to the normal distribution were expressed as(±s).Independent sample t tests were used for comparisons between groups,and paired sample t tests were used for comparisons within groups.Enumeration data were expressed as[cases(%)],andχ^(2) tests were performed.P<0.05 was considered to indicate a statistically significant difference.Results Compared with the LCBDE group,the patients in the LPH group had a longer operation time and more intraoperative blood loss(P<0.05).The levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),gamma-glutamyl transpeptidase(γ-GGT),and total bilirubin(TBIL)of the patients in both groups were higher than those before the operation at 1 day and 3 days after the operation(P<0.05),and the above indicators in the LPH group were higher(P<0.05).There was no significant difference in the incidence of postoperative complications between the LPH group and the LCBDE group(P>0.05).Compared with the LCBDE group,the patients in the LPH group had a lower residual stone rate after the operation(P<0.05).After a 36-month follow-up after the operation,there was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusion Different minimally invasive surgical methods can achieve good effects in the treatment of intrahepatic cholangiolithiasis.LCBDE has more advantages in terms of minimal invasiveness,but it is inferior to LPH in reducing the intraoperative residual stone rate.Therefore,in clinical practice,individualized treatment plans should be selected according to the actual situation of patients.
作者
张腾
韩威
冯章东
Zhang Teng;Han Wei;Feng Zhangdong(Department of General Surgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101199,China)
出处
《中华普外科手术学杂志(电子版)》
2025年第4期384-387,共4页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
2024年度北京市通州区科技计划项目(KJ2024CX034)。
关键词
肝内胆管结石
腹腔镜
肝切除术
腹腔镜胆总管切开取石术
肝功能
结石残余
Intrahepatic Cholelithiasis
Laparoscopes
Hepatectomy
Laparoscopic Common Bile Duct Exploration
Liver Function
Stone Residual
作者简介
通信作者:韩威,Email:dr-han@vip.sina.com。
