摘要
目的:分析腹腔镜左肝切除术治疗肝胆管结石的效果及影响因素。方法:选择2016年1月至2018年10月行完全腹腔镜左肝切除术的98例左肝胆管结石患者为观察组,纳入同期行开腹左肝切除术的32例左肝胆管结石患者为对照组。对比两组术中情况、术后恢复情况,记录实验室指标及术后并发症;将观察组分为疗效优良组、差组,通过对比两亚组患者资料分析影响预后的因素。结果:与对照组相比,观察组术后饮食恢复时间、住院时间短,术后白蛋白输注率低,差异有统计学意义(P<0.05);两组术中出血量、肝切除方式、并发症发生率、一期清石率差异无统计学意义(P>0.05);两组术前C反应蛋白(CRP)、白蛋白、ALT、AST、WBC水平差异无统计学意义(P>0.05);术后第1天、第3天,两组ALT、AST差异无统计学意义(P>0.05);观察组CRP、WBC水平低于对照组,白蛋白高于对照组,差异有统计学意义(P<0.05)。优良组与差组既往肝胆手术史、手术时间、术后胆道引流、活化部分凝血活酶时间差异有统计学意义(P<0.05);多因素分析显示既往肝胆手术史、手术时间≥168 min、术后胆道引流是术后效果不良的独立危险因素(P<0.05)。结论:腹腔镜左肝切除术治疗肝胆管结石的效果与开腹手术相当,腹腔镜手术后康复更快,对血清指标影响更小;有肝胆手术史、手术时间≥168 min、术后胆道引流是影响疗效的独立危险因素。
Objective:To analyze the effect and influencing factors of laparoscopic left hepatectomy for hepatolithiasis.Methods:From Jan.2016 to Oct.2018,98 patients with left hepatic bile duct calculi who underwent complete laparoscopic left hepatectomy were included in the observation group,and 32 patients with left hepatic bile duct calculi who underwent open left hepatectomy in the same period were included in the control group.The intraoperative condition and postoperative recovery was compared between the two groups,and the laboratory parameters and postoperative complications were recorded.The observation group were divided into the effective group and poor group,and the factors affecting the prognosis were analyzed by comparing the data of the two groups.Results:Compared with the control group,the postoperative dietary recovery time and hospitalization time were shorter in the observation group,and the postoperative albumin infusion rate was lower(P<0.05).There was no significant difference in intraoperative bleeding volume,the method of hepatectomy,incidence of complications and first-stage calculi removal rate between the two groups(P>0.05).There was no significant difference in preoperative CRP,ALB,ALT,AST and WBC between the two groups(P>0.05).There was no significant difference in ALT and AST between the two groups on the first and third day after surgery(P>0.05).CRP and WBC levels in the observation group were lower than those in the control group,and ALB was higher than that in the control group(P<0.05).The differences in previous history of hepatobiliary surgery,operative time,postoperative biliary drainage and activated partial thromboplastin time were statistically significant between the effective group and the poor group(P<0.05).Multivariate analysis determined that previous history of hepatobiliary surgery,operative time≥168 min,and postoperative biliary drainage were independent risk factors for poor postoperative results(P<0.05).Conclusions:The effect of laparoscopic left hepatectomy for hepatobiliary calculi is comparable to that of open surgery,and the laparoscopic left hepatectomy has advantages of faster postoperative recovery and less influence on serum parameters.Previous history of hepatobiliary surgery,operative time≥168 min,and postoperative biliary drainage are independent risk factors of curative effect.
作者
郭坤
邬仲鑫
GUO Kun;WU Zhong-xin(Department of General Surgery,Huzhou Central Hospital,Huzhou 313000,China)
出处
《腹腔镜外科杂志》
2020年第7期534-539,共6页
Journal of Laparoscopic Surgery
