本文選題：膽結(jié)石 + 肝切除術(shù)�。� 參考：《中國(guó)普通外科雜志》2016年08期

【摘要】：目的:探討應(yīng)用左肝蒂阻斷法行完全腹腔鏡左半肝切除術(shù)治療肝內(nèi)外膽管結(jié)石的可行性、安全性和有效性。方法:回顧性分析2010年月9月—2015年12月間行手術(shù)治療(左半肝切除術(shù)、膽囊切除術(shù)、膽總管切開(kāi)探查、膽道鏡探查取石、T管引流)的32例肝內(nèi)外膽管結(jié)石患者資料,其中18例患者應(yīng)用左肝蒂阻斷法行完全腹腔鏡下手術(shù)(腹腔鏡組),14例患者采用傳統(tǒng)開(kāi)腹手術(shù)(開(kāi)腹組)。比較兩組患者的相關(guān)臨床指標(biāo)。結(jié)果:兩組患者術(shù)前資料具有可比性。所有患者均順利完成手術(shù),腹腔鏡組無(wú)中轉(zhuǎn)開(kāi)腹手術(shù)。與開(kāi)腹組比較,腹腔鏡組的手術(shù)時(shí)間延長(zhǎng)(273.0 min vs.214.0 min,P0.05),手術(shù)費(fèi)用增加(5 550.0元vs.3 962.0元,P0.05),但術(shù)后丙氨酸轉(zhuǎn)氨酶水平(術(shù)后1 d:158.2 U/L vs.291.5 U/L;術(shù)后7 d:33.3 U/L vs.52.2 U/L)、疼痛緩解時(shí)間(3.2 h vs.5.0 h)、術(shù)后排氣時(shí)間(23.3 h vs.45.5 h)、術(shù)后住院時(shí)間(12.0 d vs.15.7 d)方面均有明顯優(yōu)勢(shì)(均P0.05);兩組術(shù)中出血量(226.7 m L vs.189.3 m L)、住院總費(fèi)用(41 304.4元vs.41 399.8元)、總并發(fā)癥發(fā)生率(11.2%vs.21.3%)差異無(wú)統(tǒng)計(jì)學(xué)意義(均P0.05);兩組術(shù)后均無(wú)結(jié)石殘留。結(jié)論:完全腹腔鏡下左肝蒂阻斷行左半肝切除術(shù)治療肝內(nèi)外膽管結(jié)石安全、可行、有效,雖然手術(shù)時(shí)間稍長(zhǎng),但具有創(chuàng)傷小、疼痛輕、恢復(fù)快、住院時(shí)間短等優(yōu)勢(shì),是一種值得推廣的微創(chuàng)手術(shù)。
[Abstract]:Objective: to investigate the feasibility, safety and efficacy of laparoscopic left hemihepatectomy with left hepatic pedicle occlusion in the treatment of intrahepatic and extrahepatic cholelithiasis. Methods: the data of 32 patients with intrahepatic and extrahepatic cholelithiasis underwent surgical treatment (left hemihepatectomy, cholecystectomy, choledocholithotomy, choledochoscopy) from September 2010 to December 2015 were retrospectively analyzed. Among them, 18 patients underwent complete laparoscopic surgery (laparoscopic group) with left hepatic pedicle occlusion. 14 patients underwent traditional open operation (open group). To compare the related clinical indexes between the two groups. Results: the preoperative data of the two groups were comparable. All the patients completed the operation successfully, and there was no conversion to open surgery in the laparoscopic group. Compared with the open group, In the laparoscopy group, the operation time was prolonged (273.0 min vs.214.0 / min P0.05), and the operation cost was increased (5 550.0 yuan vs.3 962.0 Yuan / U0.05), but the postoperative alanine aminotransferase level (1: 158.2 U / L vs.291.5 / UL; 7 d / 33.3 U / L vs.52.2 / ul / L), pain relief time (3.2h vs.5.0 h), postoperative time) There was no significant difference in intraoperative blood loss (226.7 mL vs.189.3 mL), total hospitalization cost (41 304.4 yuan vs.41 399.8 yuan) and total complication rate (11.2vs.21.3%) between the two groups (P0.05). There was no residual stone after operation in group A. Conclusion: left hemihepatectomy with complete laparoscopic left hepatic pedicle occlusion is safe, feasible and effective in the treatment of intrahepatic and extrahepatic cholelithiasis. Although the operative time is longer, it has the advantages of small trauma, mild pain, quick recovery and short hospital stay. It is a minimally invasive operation worth popularizing.
【作者單位】： 鄭州大學(xué)第一附屬醫(yī)院腹腔鏡外科;
【分類(lèi)號(hào)】：R657.42
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本文編號(hào)：2108920