应东建　周新华

[摘要] 目的 分析研究全腹腔镜肝切除术与传统肝切除术治疗肝内胆管结石的效果。 方法 将124例肝内胆管结石患者按照治疗方式的不同分为观察组和对照组各62例，观察组行腹腔镜下规则性左半肝切除术，对照组行常规开腹手术进行治疗。观察两组临床效果及不良反应情况。 结果 观察组手术时间、术中出血量、术后下床时间均优于对照组（P<0.05）；观察组总有效率明显高于对照组（χ2=3.815，P<0.05）；观察组术后转氨酶升高程度显著低于对照组，白蛋白水平显著高于对照组（P<0.05）；两组在术后并发症发生率方面比较差异有统计学意义（χ2=5.128，P<0.05）。两组均无围手术期死亡病例。 结论 行腹腔镜肝切除术治疗肝内胆管结石安全、微创，可作为治疗肝胆管结石的一种较好的选择在临床上使用。

[关键词] 腹腔镜；肝切除；肝胆管结石；临床应用

[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701（2015）01-0144-03

Treatment of hepatolithiasis by total laparoscopic liver resection

YING Dongjian ZHOU Xinhua

Department of Minimally Invasive Surgery， Li Huili Hospital of Ningbo Medical Center in Ningbo City， Ningbo 315041， China

[Abstract] Objective To evaluate the effect of the clinical application of laparoscopic hepatectomy and traditional liver resection in hepatolithiasis. Methods A total of 124 patients with hepatolithiasis were admitted in our hospital， and they were divided into observation group（62 cases） and control group（62cases） according to different forms of treatment. The observation group were treated with laparoscopic hepatectomy， while the control group were treated with common laparotomy. The clinical effects and adverse reactions were compared between the two groups after treatment. Results The surgial duration， intraoperative bleeding volume and get out of bed time of observation group were better than those of control group（P<0.05）； The total effective rate of the observation group was significantly higher than that of control group（χ2=3.815，P<0.05）； The degree of GPT levels postoperative in the observation group was significantly lower compared with control group and the SAB in the observation group was significantly higher compared with control group（P<0.05）. There was statistical difference in the rate of complications between the two groups（χ2=5.128， P<0.05）. There was no perioperative death. Conclusion Laparoscopic hepatectomy is an effect and minimally invasive method for hepatolithiasis patients and it is worthy of clinical use.

[Key words] Laparoscope； Hepatectomy； Hepatolithiasis； Clinical application

肝内胆管结石是指肝管分叉处以上的胆道结石，临床较为常见，可导致肝内胆管扩张或管腔相对狭窄，造成胆道机械性梗阻，从而诱发胆道感染和肝脏损伤等[1]。肝叶规则切除是治疗肝内胆管结石的有效方法之一[2]。随着腹腔镜仪器的改进，腹腔镜在肝内胆管结石肝叶切除术中的应用也逐渐在临床上得到推广[3-5]。本文对我院2013年9月～2014年3月相关患者的病历资料进行了回顾分析，现报道如下。

1 资料与方法

1.1 临床资料

本组患者124例，男59 例，女65例，年龄38～75岁，3例有腹腔镜胆囊切除手术史，全部患者均无腹部开放性手术史。术前均经B超、CT、MRI检查诊断左肝叶胆管扩张伴多发结石。82例Child分级肝功能为A级，42例为B级。将全部患者随机分为观察组和对照组。观察组62例，男31例，女31例，年龄38～75岁，平均（54.3±11.2）岁，40例Child分级肝功能为A级，22例为B级；对照组62例，男28例，女34例，年龄38～73岁，平均（55.6±10.5）岁，42例Child分级肝功能为A级，20例为B级。两组患者性别、年龄、Child分级比较无统计学意义（P>0.05），具有可比性。……