腹腔镜肝规则性切除术在肝内胆管结石患者中的应用效果观察

目的：观察肝内胆管结石应用腹腔镜肝规则性切除术治疗的可行性和效果。方法回顾性分析我院外二科2011年1月至2013年12月收治的97例肝内胆管结石患者的手术治疗情况，其中行腹腔镜肝规则性切除术42例为观察组，传统开腹肝规则切除术55例为对照组，比较两组患者的手术时间、术中出血量、术后下床时间、术后住院时间、结石清除率等。患者均随访19~60个月，比较两组患者的结石复发率。结果观察组患者术后下床活动时间、术后恢复饮食时间、术后平均住院时间较对照组短，但手术时间较对照组长，差异均有统计学意义(P<0.05)；两组并发症发生率比较差异无统计学意义(P>0.05)；观察组结石即时清除率和最终清除率分别为92.86%(39/42)和100.00%(42/42)；对照组为94.54%和100.00%(42/42)，差异均无统计学意义(P>0.05)；97例患者平均随访47.9个月，观察组患者的优秀率和复发率分别为76.19%(32/42)、4.76%(2/42)，对照组为76.36%(42/55)、5.45%(3/55)，差异均无统计学意义(P>0.05)。结论腹腔镜肝规则性切除术治疗肝内胆管结石具有可行性，而且安全微创，可达到开腹手术同样的效果。

Feasibility and effect of regular laparoscopic hepatectomy in patients with intrahepatic bile duct stones

Objective To observe the feasibility and effect of regular laparoscopic hepatectomy in the treat-ment of patients with intrahepatic bile duct stones. Methods Retrospective analysis was performed in 97 patients of in-trahepatic bile duct stones treated in the Second Department of Surgery in our hospital from January 2011 to December 2013, including 42 patients undergoing regular laparoscopic hepatectomy (observation group) and 55 patients undergo-ing traditional laparotomy (control group). Operation time, intraoperative blood loss, postoperative off-bed time, length of postoperative hospital stay, stone clearance rate were compared between the two groups. The patients were followed up for 19~60 months, and the recurrence rate were compared. Results The postoperative off-bed time, postoperative di-et recovery time, the average length of hospital stay in the observation group were shorter than those in the control group, but the operation time was significantly longer (P<0.05). The incidence of complications showed no statistically significant difference between the two groups (P>0.05). The real-time calculi clearance rate, final clearance rate were 92.86%, 100.00%in the observation group and 94.54%, 100.00%in the control group, with no statistically significant difference (P>0.05). The patients were followed up for 47.9 months in average, and the excellence rate and recurrence rate showed no statistically significant difference between the observation group and the control group (76.19%vs76.36%, 4.76%vs 5.45%, P>0.05). Conclusion Regular laparoscopic hepatectomy is feasible and safe for treatment of intrahepatic bile duct stones, which can obtain similar effect with traditional laparotomy.