肝内胆管结石患者行腹腔镜左肝切除术后远期生存质量的影响因素分析

目的:探讨肝内胆管结石行腹腔镜左肝切除术后远期生存质量的影响因素。方法:回顾分析2010年1月至2017年12月216例肝内胆管结石患者行腹腔镜左肝切除术的临床资料,根据远期生存质量情况分组,分析患者术后远期生存质量的影响因素。结果:79例行左半肝切除术,137例行左外叶切除术;术后随访25~80个月,中位随访时间34.0个月;随访评价生存质量良好192例,不佳24例;其中结石残留22例、复发16例、胆管炎反复发作24例、死亡6例。单因素分析结果显示,性别、肝胆手术史、血肌酐、白蛋白、活化部分凝血活酶时间、胆道镜使用情况、术后胆道引流情况、手术时间及术后结石残留情况与腹腔镜左肝切除术后远期生存质量有关(P<0.05)。多因素分析结果显示,肝胆手术史、术后胆道引流情况及手术时间是肝内胆管结石患者微创左肝切除术后远期生存质量的独立影响因素(P<0.05)。结论:有肝胆手术史、术后胆道引流及手术时间≥240 min的肝内胆管结石患者远期生活质量更差,预后不良风险更高。

Influencing factors analysis on long-term quality of life in patients with hepatolithiasis after laparoscopic left hepatectomy

Objective:To investigate the influencing factors of long-term quality of life in patients with hepatolithiasis after laparoscopic left hepatectomy.Methods:Clinical data of 216 patients with hepatolithiasis who underwent laparoscopic left hepatectomy from Jan.2010 to Dec.2017 were retrospectively analyzed.All patients were divided into different groups according to the long-term quality of life;the influencing factors of long-term quality of life were analyzed by univariate and multivariate analysis.Results:There were 79 cases of left hemihepatectomy and 137 cases of left lateral hepatic lobectomy.The patients were followed up for 25-80 months with median time of 34.0 months.There were 192 cases with good quality of life and 24 cases with poor quality of life according to the follow-up quality of life evaluation,including 20 cases of residual stones,16 cases of calculus recurrence,24 cases of recurrent cholangitis and 6 cases of death.Univariate analysis showed that gender,history of hepatobiliary surgery,serum creatinine,albumin,activated partial thromboplastin time,choledochoscopy,postoperative biliary drainage,operation time and postoperative residual calculi were related to long-term quality of life after laparoscopic left hepatectomy(P<0.05).Multivariate analysis showed that the history of hepatobiliary surgery,postoperative biliary drainage and operation time were the independent influencing factors of long-term quality of life in patients with hepatolithiasis after laparoscopic left hepatectomy(P<0.05).Conclusions:Hepatolithiasis patients with hepatobiliary surgery,postoperative biliary drainage and operation time≥240 min have worse long-term quality of life and higher risk of poor prognosis.