2021 年第 1 期 第 16 卷

腹腔镜左肝蒂阻断术治疗肝内胆管结石效果观察

Effect observation of laparoscopic left hepatic pedicle occlusion in the treatment of hepatolithiasis

作者：沈学艺陈宇锋王艺敏刘敏超陈锦鸿陈德烽

英文作者：Shen Xueyi Chen Yufeng Wang Yimin Liu Minchao Chen Jinhong Chen Defeng

单位：福建省漳州市医院肝胆胰脾疝外科363000

英文单位：Department of Hepatobiliary Pancreatic and Splenic Hernia Surgery Zhangzhou Municipal Hospital of Fujian Province Zhangzhou 363000 China

关键词：肝内胆管结石；腹腔镜；左肝蒂阻断；开腹手术

英文关键词：

• 摘要：

• 目的 探讨腹腔镜左肝蒂阻断术治疗肝内胆管结石的效果。方法 选取福建省漳州市医院2017年4月至2019年5月收治的108例肝内胆管结石患者，根据随机数字表法分为腹腔镜组和开腹组，各54例。开腹组患者行开腹手术治疗；腹腔镜组患者行腹腔镜左肝蒂阻断术治疗。比较2组患者围术期资料、不同时点肝功能指标、生活质量水平和并发症发生情况。结果腹腔镜组手术时间明显长于开腹组［（270±54）min比（212±33）min］，切口长度、术中失血量、术后镇痛时间、术后排气时间、术后住院时间均明显短于/少于开腹组［（3.5±0.5）cm比（21.8±1.9）cm、（189±54）ml比（220±64）ml、（3.1±1.1）h比（5.2±1.6）h、（22±7）h比（47±12）h、（11.8±2.2）d比（16.3±3.1）d］，差异均有统计学意义（均P<0.05）。2组患者术前和术后1、3、7 d天冬氨酸转氨酶、丙氨酸转氨酶、总胆红素、白蛋白水平比较差异均无统计学意义（均P＞0.05）。术后1个月2组SF-36健康状况调查量表评分明显高于术前，且腹腔镜组明显高于开腹组［（72±8）分比（64±47）分］，差异均有统计学意义（均P<0.05）。腹腔镜组并发症发生率明显低于开腹组［11.1%(6/54)比33.3%(18/54)］，差异有统计学意义（P＜0.05）。结论 腹腔镜左肝蒂阻断术治疗肝内胆管结石手术创伤小、患者术后恢复快，且并发症较少。

• Objective To investigate the effect of laparoscopic left hepatic pedicle occlusion in the treatment of hepatolithiasis. Methods From April 2017 to May 2019,108 patients with hepatolithiasis in Zhangzhou Municipal Hospital of Fujian Province were randomly divided into laparoscopic group and open group, with 54 cases in each group. Patients in laparoscopic group were treated with laparoscopic left hepatic pedicle occlusion, and patients in open group were treated with open surgery. The perioperative data, liver function indexes at each time point, quality of life and complications were compared between the two groups. Results The operation time of laparoscopic group was significantly longer than that of open group［(270±54)min vs （212±33)min］, the incision length, intraoperative blood loss, postoperative analgesia time, postoperative exhaust time and hospitalization time in laparoscopic group were significantly shorter/less than those in open group ［(3.5±0.5)cm vs (21.8±1.9)cm, (189±54)ml vs (220±64)ml, (3.1±1.1)h vs (5.2±1.6)h, (22±7)h vs (47±12)h, (11.8±2.2)d vs (16.3±3.1)d］(all P<0.05). There were no significant differences in levels of aspartate aminotransferase, alanine aminotransferase, total bilirubin and albumin between the two groups at the same time point before and 1, 3 and 7 d after operation (all P＞0.05). One month after operation, the SF-36 life quality scores of both groups were higher than those before operation, and that of laparoscopic group was significantly higher than that of open group［（72±8） vs （64±47）］(all P<0.05). The incidence of complications in laparoscopic group was significantly lower than that in open group［11.1%(6/54) vs 33.3%(18/54)］(P<0.05). Conclusion Laparoscopic left hepatic pedicle occlusion in the treatment of hepatolithiasis has the advantages of small operation trauma, quick postoperative recovery and fewer complications.