本文選題：腹腔鏡肝切除術　切入點：規(guī)則性左肝切除　出處：《中國微創(chuàng)外科雜志》2017年05期

【摘要】：目的探討全腹腔鏡規(guī)則性左肝切除治療肝膽管結石的安全性與有效性。方法選取我院2011年1月~2016年1月肝膽管結石行規(guī)則性左肝切除104例,其中全腹腔鏡規(guī)則性左肝切除33例(腹腔鏡組),開腹手術71例(開腹組),比較2組手術時間、術中出血、術后恢復飲食時間、術后住院時間、術后白蛋白使用情況、術后并發(fā)癥、一期清石率、總清石率等。結果腹腔鏡組手術時間明顯長于開腹組[(199.4±62.9)min vs.(173.6±36.6)min,t=2.635,P=0.010],術后恢復飲食時間明顯短于開腹組[(1.7±0.9)d vs.(3.1±0.9)d,t=-7.383,P=0.000],術后住院時間明顯短于開腹組[(7.9±2.3)d vs.(10.1±2.8)d,t=-3.936,P=0.000]。腹腔鏡組術后白蛋白使用率明顯低于開腹組[12.1%(4/33)vs.39.4%(28/71),χ~2=7.891,P=0.005]。腹腔鏡組術后第1、3天WBC計數(shù)明顯低于開腹組[(11.5±1.2)×109/L vs.(14.9±2.1)×109/L,t=-8.653,P=0.000;(8.9±1.8)×109/L vs.(11.0±2.0)×109/L,t=-5.139,P=0.000];術后第1、3天CRP明顯低于開腹組[(28.4±3.9)mg/L vs.(58.8±20.4)mg/L,t=-8.468,P=0.000;(13.2±3.2)mg/L vs.(30.9±7.6)mg/L,t=-12.834,P=0.000];術后第1、3天ALB明顯高于開腹組[(33.0±2.7)g/L vs.(31.1±3.1)g/L,t=3.026,P=0.003;(35.2±1.8)g/L vs.(33.6±2.4)g/L,t=3.407,P=0.000]。2組出血量[(213.4±169.3)ml vs.(240.8±91.9)ml,t=-1.069,P=0.287]、肝切除方式(χ~2=3.625,P=0.057)、術后第1和3天TBIL17.1μmol/L百分比[45.4%(15/33)vs.38.0%(27/71),χ~2=0.516,P=0.473;30.3%(10/33)vs.23.9%(17/71),χ~2=0.474,P=0.491]、術后1和3天ALT[(99.2±31.8)U/L vs.(107.9±41.1)U/L,t=-1.075,P=0.285;(56.1±14.2)U/L vs.(65.2±31.9)U/L,t=-1.565,P=0.121]、術后1和3天AST[(77.7±25.9)U/L vs.(87.0±35.0)U/L,t=-1.362,P=0.176;(45.0±9.3)U/L vs.(51.1±18.8)U/L,t=-1.763,P=0.081]、術后清石率[一期清石率84.3%(28/33)vs.87.8%(62/71),χ~2=0.001,P=0.972;最終清石率100.0%(33/33)vs.97.2%(69/72),Fisher精確檢驗,P=1.000]均無統(tǒng)計學差異。2組術后并發(fā)癥發(fā)生率無統(tǒng)計學差異[12.1%(4/33)vs.21.1%(15/71),χ~2=1.224,P=0.269]。結論腹腔鏡規(guī)則性左肝切除術治療肝膽管結石安全、有效。
[Abstract]:Objective to evaluate the safety and efficacy of laparoscopic left hepatectomy in the treatment of hepatolithiasis.Methods A total of 104 patients with hepatolithiasis underwent regular left hepatectomy from January 2011 to January 2016 in our hospital. Among them, 33 cases underwent laparoscopic regular left hepatectomy (laparoscopic group) and 71 cases underwent open hepatectomy (laparotomy group). The operative time and intraoperative bleeding were compared between the two groups.Postoperative recovery time, postoperative hospitalization time, postoperative albumin use, postoperative complications, primary stone removal rate, total stone removal rate, etc.The postoperative albumin utilization rate in the laparoscopy group was significantly lower than that in the open group [12.1R = 4 / 33vs.39.4, 蠂 ~ (2 +) 7.891 / P ~ (0.005)].鑵硅厰闀滅粍鏈悗絎，

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