腹腔镜与开腹左肝外叶切除联合胆道镜取石治疗左肝内胆管结石的疗效比较

目的:比较腹腔镜与开腹左肝外叶切除联合胆道镜取石术治疗左肝内胆管结石的疗效。方法:回顾性分析2010年9月—2013年9月收治的45例左肝内胆管结石患者资料,其中23例行腹腔镜左肝外叶切除+胆道镜取石术(腹腔镜组)、22例行开腹肝外叶切除+胆道镜取石术(开腹组)。结果:腹腔镜组在术后下床活动时间、肠道功能恢复时间、进食时间、住院时间以及术后疼痛等方面优于开腹组(均P0.05);而两组间手术时间、术中出血、肝功能指标、住院总费用方面差异无统计学意义(均P0.05)。术后两组均无结石残余;腹腔镜组发生胆汁漏1例,开腹组发生肝断面积液1例,均经保守治疗治愈。随访43例,无结石复发及腹痛、黄疸、肝功能异常等。结论:腹腔镜左肝外叶切除联合胆道镜取石术治疗左肝外叶胆管结石与开腹途径相比疗效相当,但腹腔镜组术后恢复快,可作为该类疾病的首选治疗方式。

Laparoscopic versus open left lateral hepatic lobectomy plus choledochoscopic stone extraction for left lobe hepatolithiasis

Objective: To compare the efficacy of laparoscopic and open left lateral hepatic lobectomy combined with choledochoscopic stone extraction for left hepatolithiasis. Methods: The clinical data of 45 patients with left intrahepatic duct stones treated from September 2010 to September 2013 were retrospective analyzed. Of the patients, 23 cases received laparoscopic left lateral hepatic lobectomy plus choledochoscopic stone extraction (laparoscopic group), and 22 cases were subjected to open left lateral hepatic lobectomy plus choledochoscopic stone removal (laparotomy group). Results: Laparoscopic group was superior to laparotomy group in the variables of time to regain ambulation, intestinal function recovery and food intake, length of postoperative stay and postoperative pain (all P<0.05), while the operative time, intraoperative blood loss, live function parameters and hospitalization costs between the two groups showed no significant difference (all P>0.05). After operation, no residual stone was noted in either of both groups of patients; bile leakage occurred in one case in laparoscopic group and biliary collection on the hepatic resection surface occurred in one case in laparotomy group respectively, which were all resolved by conservative treatment. Forty-three cases were followed up, in whom no stone recurrence, abdominal pain, jaundice or abnormal liver function was noted. Conclusion: Laparoscopic left lateral hepatic lobectomy plus choledochoscopic stone extraction has similar efficacy as open approach in treatment of left intrahepatic duct stones, but it allows a quick postoperative recovery, so it is recommended as the first therapeutic option for this condition.