本文選題：肝內(nèi)膽管結(jié)石 + 腹腔鏡肝切除術(shù)��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景:肝內(nèi)膽管結(jié)石是一種臨床上常見的復(fù)雜疾病,目前規(guī)則性的肝葉切除術(shù)仍然是其標(biāo)準(zhǔn)外科治療方式,近年來腹腔鏡應(yīng)用越來越廣泛,但其肝膽結(jié)石病反復(fù)感染導(dǎo)致的腹腔內(nèi)粘連及解剖變異限制了腹腔鏡肝切除術(shù)在本病的應(yīng)用。研究目的:評估比較腹腔鏡與開腹肝切除術(shù)治療肝內(nèi)膽管結(jié)石圍手術(shù)期及臨床療效,分析腹腔鏡治療肝內(nèi)膽管結(jié)石的可行性、有效性及其優(yōu)勢。研究方法:回顧性分析從2012年1月1日至2017年1月1日就診于山東大學(xué)齊魯醫(yī)院接受手術(shù)治療的肝內(nèi)膽管結(jié)石病人相關(guān)資料,其中22位患者接受腹腔鏡肝切除術(shù),包括左半肝切除術(shù)(n=7)左外葉切除術(shù)(n=14)右半肝切除術(shù)(n=1),30位患者接受開腹肝切除術(shù),包括左半肝切除術(shù)(n=7)左外葉切除術(shù)(n=18)右半肝切除術(shù)(n=2)右肝部分切除術(shù)(n=3).根據(jù)病歷資料及隨訪資料,對兩組患者圍手術(shù)期及臨床效果進(jìn)行比較,包括患者年齡、性別、體質(zhì)量指數(shù)、結(jié)石位置、術(shù)前白蛋白、術(shù)后白蛋白、手術(shù)時(shí)間、術(shù)中失血量、術(shù)后輸血情況、術(shù)后肝功、術(shù)后膽紅素、術(shù)后拔管時(shí)間、禁食時(shí)間、術(shù)后住院時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥、結(jié)石清除率、結(jié)石復(fù)發(fā)率等。應(yīng)用SPSS 23.0軟件對各組數(shù)據(jù)進(jìn)行錄入及統(tǒng)計(jì)分析,計(jì)量資料用x±s表示,應(yīng)用t檢驗(yàn),計(jì)數(shù)資料用率表示,應(yīng)用χ 2檢驗(yàn)。P值均表示雙側(cè)概率,顯著性水平α =0.05,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:滿足納入標(biāo)準(zhǔn)者有52例,腹腔鏡組22例,開腹組30例,兩組患者年齡(58.64±9.209vs53.60±9.099 歲,p=0.055)、性別(9:13vs9:21 男:女,p=0.414)、BMI(13:9vs18:12,24:≥24,p=0.947)、肝功能(20:2vs27:3,child 分級 A:B,p=0.913)、術(shù)前血清白蛋白(42.145±2.900vs39.917±5.993 g\L,p=0.083)等術(shù)前一般指標(biāo)無差異;腹腔鏡組相對于開腹組術(shù)中出血更少(117.27±67.414vs 269.33±369.771 ml,p=0.035),術(shù)后并發(fā)癥更少(9.1%vs 36.7%,p=0.028),術(shù)后禁食時(shí)間短(2.77±0.922 vs 3.80± 1.972 天,p=0.016),術(shù)后轉(zhuǎn)氨酶水平低(谷丙轉(zhuǎn)氨酶93.95±48.958 vs 201.13± 166.683 IU\L,p=0.002;谷草轉(zhuǎn)氨酶89.50±57.138vs219.70±236.520IU\L,p=0.007),術(shù)后血清白蛋白水平高(36.695±4.546 vs 30.703±4.831 g\L,p=0.000),術(shù)后引流管拔除時(shí)間早(8.59±3.699 vs 16.57±10.523 天,p=0.000),術(shù)后住院時(shí)間短(11.23±3.308 vs19.80±11.158 天,p=0.024),術(shù)后抗生素應(yīng)用時(shí)間短(5.86±2.315 vs 7.93±4.025天,p=0.024),而手術(shù)時(shí)間(236.36±104.769 vs 264.17±113.624 分鐘,p=0.372)、術(shù)中輸血(4.5%vs 20.0%,p=0.107)、術(shù)后總膽紅素(20.873±20.697 vs 27.110±18.309 umol\L,p=0.256)、術(shù)后三天平均引流量(76.14±74.573 vs 89.87±60.835 ml,p=0.468)、術(shù)后輸血(9.1%vs 13.3%,p=0.636)、結(jié)石清除率(初次手術(shù)結(jié)石清除率86.4%vs 73.3%,p=0.256;最終結(jié)石清除率100%vs 96.7%,p=0.387)、結(jié)石復(fù)發(fā)率(0%vs 6.7%,p=0.502)、治療費(fèi)用(48640.45±18879.721 vs 41274.87± 14152.497 元,p=0.114)無明顯差異。結(jié)論:腹腔鏡肝切除術(shù)治療肝內(nèi)膽管結(jié)石安全有效,能夠達(dá)到與開腹手術(shù)一樣的療效,并有術(shù)中出血少、術(shù)后并發(fā)癥少、術(shù)后禁食時(shí)間短、肝功能影響小、術(shù)后住院時(shí)間短、對患者創(chuàng)傷小等優(yōu)勢,值得臨床推廣應(yīng)用。
[Abstract]:Background: intrahepatic cholangiolithiasis is a common and complex disease. Currently, regular lobectomy is still a standard surgical treatment. In recent years, the application of laparoscopy is becoming more and more extensive. However, intraperitoneal adhesion and anatomical variation caused by repeated infection of hepatolithiasis are limited by laparoscopic hepatectomy in this disease. Objective: To evaluate the perioperative and clinical efficacy of laparoscopic and open hepatectomy for intrahepatic bile duct stones, and to analyze the feasibility, effectiveness and advantages of laparoscopy in the treatment of intrahepatic bile duct stones. A retrospective analysis from January 1, 2012 to January 1, 2017 in Qilu Hospital of Shandong University was treated by surgical treatment. 22 patients received laparoscopic hepatectomy, including Zuo Bangan resection (n=7) left lateral lobectomy (n=14) right hemihepatectomy (n=1), and 30 patients received open hepatectomy, including left hemihepatectomy (n=7) left lateral lobectomy (n=18) right hemihepatectomy (n=2) right liver partial resection (n=2). N=3). According to the medical records and follow-up data, the perioperative and clinical effects of the two groups were compared, including patient's age, sex, body mass index, stone position, preoperative albumin, postoperative albumin, operation time, blood loss, postoperative blood transfusion, postoperative liver function, postoperative bilirubin, postoperative extubation time, fasting time, postoperative residence. Hospital time, hospitalization expenses, postoperative complications, stone clearance rate, calculi recurrence rate and so on. SPSS 23 software was used to record and analyze the data of each group. The measurement data were expressed in X + s, t test was used, the use rate of counting data was expressed, and the.P value of the x 2 was used to show bilateral probability, the significant level was alpha =0.05, and the difference of P0.05 was statistically significant Results: there were 52 cases of inclusion criteria, 22 cases in laparoscopy group, 30 cases in open group, two group of patients (58.64 + 9.209vs53.60 + 9.099 years old, p=0.055), sex (9:13vs9:21 male: female, p=0.414), BMI (13:9vs18:12,24: > 24, p=0.947), liver function (20: 2vs27:3, child grade A:B, p=0.913), and preoperative serum albumin (42.145 + + 5.). 993 gL, p=0.083) had no difference before operation, and there were less bleeding in laparoscopy group (117.27 + 67.414vs 269.33 + 369.771 ml, p=0.035), less postoperative complications (9.1%vs 36.7%, p=0.028), short time after operation (2.77 + 0.922 vs 3.80 + 1.972 days, p=0.016), and low level of transaminase after operation (93.95 + 48.95. 8 vs 201.13 + 166.683 IUL, p=0.002, 89.50 + 57.138vs219.70 + 236.520IUL, p=0.007), after operation, the level of serum albumin was high (36.695 + 4.546 vs 30.703 + 4.831 gL, p=0.000), and the drainage time was early (8.59 + 3.699 vs 16.57 + 10.523 days, p= 0). 24) after operation, the time of antibiotic application was short (5.86 + 2.315 vs 7.93 + 4.025 days, p=0.024), and the operation time (236.36 + 104.769 vs 264.17 + 113.624 minutes, p=0.372), intraoperative blood transfusion (4.5%vs 20%, p=0.107), postoperative total bilirubin (20.873 + 20.697 vs 27.110 + umolL, p=0.256). 35 ml, p=0.468), postoperative blood transfusion (9.1%vs 13.3%, p=0.636), stone clearance rate (86.4%vs 73.3%, p=0.256; final stone clearance 100%vs 96.7%, p=0.387), calculi recurrence rate (0%vs 6.7%, p=0.502), treatment cost (48640.45 + 18879.721 vs 41274.87 + 14152.497 yuan, p=0.114) no significant difference. Conclusion: laparoscopic liver Resection of intrahepatic bile duct stones is safe and effective, and can achieve the same effect as open surgery, with less bleeding, less postoperative complications, short post operation time, small effect of liver function, short hospital stay, and small trauma to patients. It is worthy of clinical application.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R657.3

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