临床外科杂志 ›› 2022, Vol. 30 ›› Issue (6): 572-575.doi: 10.3969/j.issn.1005-6483.2022.06.020

• 论著 • 上一篇    下一篇

开腹和腹腔镜肝切除术治疗复杂肝胆管结石的疗效评价和策略分析

  

  1. 650000 云南,昆明医科大学第二附属医院肝胆胰外科二病区 
  • 收稿日期:2021-10-11 接受日期:2021-10-11 出版日期:2022-06-20 发布日期:2022-06-20
  • 通讯作者: 戈佳云,Email:gjy520@163.com

Efficacy evaluation and strategy analysis of open and laparoscopic hepatectomy for complicated hepatolithiasis

  1. The Second Department of Hepatobiliary Surgery,the Second Affiliated Hospital,Kunming Medical University,Kunming 650000,China
  • Received:2021-10-11 Accepted:2021-10-11 Online:2022-06-20 Published:2022-06-20

摘要: 目的 探讨复杂肝胆管结石肝部分切除术的疗效和策略。方法 2019年10月~2020年10月我院收治复杂肝胆管结石病人56例,按手术方式分为开腹肝部分切除术组(32例)和腹腔镜下肝部分切除术组(24例),所有病人常规行胆道镜胆道探查,比较两组病人手术方式、手术时间、术中出血量、住院时间、术后并发症发生率、结石残余率和复发率。结果 开腹手术组手术时间为(367.81±113.46)分钟,术中出血量534.00(300.00,1000.00)ml,住院时间(25.16±7.51)天;腹腔镜手术组分别为(320.46±110.89)分钟,200.00(200.00,600.00)ml,(19.71±6.55)天,两组术中出血量、住院时间比较,差异有统计学意义(P<0.05)。开腹手术组术后胆漏2例(6.25%),术后存在残余结石10例(31.25%),结石复发3例(9.38%);腹腔镜手术组残余结石3例(12.5%),结石复发2例(8.33%),两组术后并发症、结石残余率和复发率比较,差异无统计学意义(P>0.05)。结论 复杂肝胆管结石肝切除术前先进行胆道引流,术中无法行解剖性肝切除者应尽量切除病灶。腹腔镜手术术中出血量少、 住院时间短,联合PTCS、ERCP等技术可以使复杂肝胆管结石的治疗精准化、微创化。

关键词: 复杂肝胆管结石, 肝部分切除术, 疗效, 策略

Abstract: Objective To explore the efficacy and strategy of hepatectomy for complicated hepatolithiasis.Methods Fifty-six patients with complicated hepatolithiasis were divided into open hepatectomy group (32 cases) and laparoscopic hepatectomy group (24 cases).The operation mode,operation time,operation bleeding volume,hospitalization time,postoperative complication rate,residual stone rate and recurrence rate were analyzed.Results The operation time was (367.81±113.46) minutes,the operation bleeding volume was 534.00(300.00,1 000.00) ml,and the hospitalization time was (25.16±7.51) days in open surgery group.The operation time was (320.46±110.89) minutes,the operation bleeding volume was 200.00(200.00,600.00) ml,and the hospitalization time was (19.71±6.55) days in laparoscopic surgery group.There were statistically significant differences between the two groups in the operation bleeding volume and hospitalization time (all P<0.05).Bile leakage occurred in 2 cases (6.25%) and residual stones in 10 cases (31.25%),3 cases had recurrence of calculi(9.38%).Laparoscopic operation group:3 cases (12.5%) had residual stones,3 cases had recurrence of calculi(8.33%) .There were no statistically significant differences in postoperative complications,stone remnant and recurrence rates between the two groups(P>0.05).Conclusions Biliary drainage should be completed before hepatectomy for complicated hepatolithiasis.If it is difficult to perform anatomic hepatectomy,the lesion should be removed as far as possible.Laparoscopic surgery has the advantages of less bleeding and shorter hospital stay.Combined with PTCS,ERCP and other technologies can make the treatment of complex hepatolithiasis accurate and minimally invasive.

Key words: complicated hepatolithiasis, hepatectomy, efficacy;strategy

[1] 廖黄峻清 张秋红 郭震浪 向松涛. 影像学与人工智能在预测体外冲击波碎石疗效中的运用[J]. 临床外科杂志, 2022, 30(2): 105-108.
[2] 陈家财 曾宾华 李金雨 罗辉 林山. 腹腔镜下肾动脉阻断肾部分切除术治疗cT1期肾癌的疗效及对肾功能的影响[J]. 临床外科杂志, 2022, 30(2): 121-124.
[3] 佘明杰 徐永建 张佩君 付强 卢伟 刘小虎. 早期和延期腹腔镜胆囊切除术治疗胆囊结石性胰腺炎疗效分析[J]. 临床外科杂志, 2022, 30(2): 186-188.
[4] 芦斌 梁立卓. 人工股骨头置换术治疗老年股骨粗隆间骨折的手术学指标及骨密度、髋关节功能变化观察[J]. 临床外科杂志, 2022, 30(2): 193-195.
[5] 李小川 黄春明 罗绍坚 范武 董智晖 蓝根 卢明南 林强祯 陆军海韦健 黎欲强 黄冀. 颈前路Hybrid术式治疗跳跃节段颈椎病的临床观察[J]. 临床外科杂志, 2022, 30(1): 65-69.
[6] 曾佩 刘莹. 不同肾盂漏斗部夹角肾下盏结石病人采用不同术式的疗效及疗效相关因素分析[J]. 临床外科杂志, 2022, 30(1): 78-81.
[7] 辛国军 王建承 翁原驰 张俊. 全胰腺切除术9例临床疗效分析[J]. 临床外科杂志, 2021, 29(7): 619-621.
[8] 顾越雷 郭德凯 李镇伽 江雨波 刘蕾. 腹腔镜胆总管切开探查取石+腹腔镜胆囊切除术与经内镜逆行胰胆管造影/内镜下括约肌切开取石+腹腔镜胆囊切除术治疗结石性急性梗阻性化脓性胆管炎的疗效比较[J]. 临床外科杂志, 2021, 29(7): 622-625.
[9] 刘高利 王新 胡海峰 宋恒雅 黄杰 谢颂平. 分期手术策略在结肠代食管术中的应用分析[J]. 临床外科杂志, 2021, 29(7): 643-645.
[10] 李鑫, 顾绍栋, 罗洪等. 治疗性血管新生在尿道下裂手术中的应用分析[J]. 临床外科杂志, 2021, 29(6): 514-516.
[11] 李干斌 韩加刚 王振军 魏广辉 渠浩 翟志伟 易秉强 马华崇 杨勇王建良 李竹林. 新辅助放化疗治疗局部进展期直肠癌的远期疗效及预后因素分析[J]. 临床外科杂志, 2021, 29(5): 422-427.
[12] 马鑫, 宣云东, 黄庆波, 张旭. 肾癌合并下腔静脉癌栓的机器人手术策略[J]. 临床外科杂志, 2021, 29(2): 104-107.
[13] 王全晖, 拜云虎, 袁守信. 双镜联合治疗胆总管结石术中不同一期缝合方式对病人的疗效及预后的影响评估[J]. 临床外科杂志, 2021, 29(2): 181-183.
[14] 聂金琳, 张浩然, 陈长顺. Castleman病三例[J]. 临床外科杂志, 2021, 29(2): 199-200.
[15] 翟荣华 佘勇军 邢春花. 小潮气量联合低呼气末正压通气对腹腔镜肝部分切除术病人出血量及术后应激反应的影响[J]. 临床外科杂志, 2021, 29(12): 1192-1195.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 李光焰;张安平;王祥峰;等. 直肠癌切除术后吻合口狭窄14例分析[J]. 临床外科杂志, 2016, 24(10): 772 .
[2] 张忠伟;刘扬;路明. 痔上黏膜环切术治疗直肠前突所致出口梗阻型便秘的疗效观察[J]. 临床外科杂志, 2016, 24(10): 774 .
[3] 肖国栋;刘国辉. 跗骨窦切口联合经皮置钉技术微创治疗跟骨骨折的临床疗效分析[J]. 临床外科杂志, 2016, 24(10): 783 .
[4] 杨钦;张再重;王烈. 空肠间置术在Siewert Ⅱ型食管胃结合部腺癌中的应用[J]. 临床外科杂志, 2016, 24(11): 816 .
[5] 应敏刚;杨春康. 腹腔镜胃癌根治术并发症的防治策略[J]. 临床外科杂志, 2016, 24(11): 819 .
[6] 石汉平. 胃癌围手术期营养治疗[J]. 临床外科杂志, 2016, 24(11): 821 .
[7] 林伟箭;洪雪辉;许淑镇;等. 吸引器在腹腔镜胃癌根治术中的应用体会[J]. 临床外科杂志, 2016, 24(11): 824 .
[8] 吴川清;刘炜圳;帅晓明;等. 超声内镜在胃癌术前诊断中的应用分析[J]. 临床外科杂志, 2016, 24(11): 828 .
[9] 方军;余阳;许涛;等. 小野寺营养预后指数在胃癌患者预后评估中的价值[J]. 临床外科杂志, 2016, 24(11): 831 .
[10] 王维君;那光玮;何科基;等. 根治性淋巴结清扫联合脾切除在残胃癌手术中的临床意义探究[J]. 临床外科杂志, 2016, 24(11): 835 .