腹腔镜左肝外叶切除+胆道镜取石术治疗左肝内胆管结石的临床研究

目的 :探讨腹腔镜左肝外叶切除+胆道镜取石术治疗左肝内胆管结石的临床效果.方法 :根据不同术式将89例左肝内胆管结石患者分为观察组与对照组,观察组采取腹腔镜左肝外叶切除+胆道镜取石术治疗,对照组行开腹左肝外叶切除术+胆道镜取石术,比较两组临床疗效.结果 :两组结石残留率及随访1年结石复发率比较差异无统计学意义;观察组平均术后下床活动时间、肠功能恢复时间及住院时间较对照组显著短;观察组并发症总发生率为17.78%显著低于对照组的36.36%,差异有统计学意义.结论 :腹腔镜左肝外叶切除+胆道镜取石术与开腹左肝外叶切除术+胆道镜取石术治疗左肝内胆管结石在术后结石残留、结石复发减少方面效果类似,但腹腔镜联合术式术后胃肠功能恢复快,并发症明显少,更安全,可作为左肝内胆管结石治疗的重要术式之一.

Clinical study of laparoscopic hepatic left lateral lobectomy and choledochoscopic stone removal in the treatment of left hepatolithiasis

Objective To investigate the clinical effect of laparoscopic hepatic left lobectomy and choledochoscopic stone removal in the treatment of left hepatolithiasis. Methods Eighty-nine patients with left hepatolithiasiswere divided into obser-vation group and control group according to different operation methods. The observation group was treated by laparoscopic he-patic left lobectomy and choledochoscopic stone removal, while the control group was treated by open hepatic left lobectomy and choledochoscopic stone removal, and the clinical effect was compared between the two groups. Results There were no signifi-cant differences in the rates of residual stone and 1-year recurrence rate between the two groups(P > 0.05); The average time of postoperative off-bed activities, time of bowel functional recovery and length of stay in observation group were significantly shorter than those in control group; The total incidence rate of complications in the observation group (17.78%) was significantly lower than that in the control group (36.36%). Conclusion The effects of laparoscopic hepatic left lobectomy combined with choledochoscopic stone removal are similar to those ofopen hepatic left lobectomy combined with choledochoscopic stone re-moval in the treatment of left hepatolithiasis, interms of residual stone and recurrence of stones. However, the bowel functional can recover more quickly after laparoscopic hepatic left lobectomy combined with choledochoscopic stone removal, with few complications, and it is safer. It can be used as one of the important methods for treating left hepatolithiasis.