殷喆

[摘 要] 目的：比较腹腔镜与开腹左半肝切除治疗肝内胆管结石疗效及卫生经济学特点。方法：回顾分析2010年8月—2015年8月收治确诊左肝区域型肝内胆管结石患者资料。按照治疗方案，40例为腹腔镜组，37例为开腹组，比较两组患者围术期情况、并发症发生情况及随访结局，分析两种治疗方案的卫生经济学特点。结果：腹腔镜组手术时间高于对照组，其腹腔引流量、止痛药物使用量、肛门排气时间、下床活动时间、引流管拔除时间、拆线时间、住院时间低于对照组，差异有统计学意义（P<0.05），两组患者术中出血量比较，差异无统计学意义（P>0.05）。腹腔镜组并发症发生率为10.00%，低于开腹组的40.54%，差异有统计学意义（P<0.05）。两组患者结石清除率、手术疗效、术后复发率比较，差异无统计学意义（P>0.05）。腹腔镜组费用效用（CUR）、增量费用效用（ICUR）均低于开腹组，其卫生经济学指标优于后者。结论：与开腹左半肝切除治疗肝内胆管结石相比，腹腔镜术式能够在保证临床疗效的前提下进一步提高患者恢复速度、降低治疗风险，且经济性更佳。

[关键词] 腹腔镜；开腹；左半肝切除；肝内胆管结石；卫生经济学

中图分类号：R 657.3 文献标识码：B 文章编号：2095-5200（2016）04-050-03

DOI：10.11876/mimt201604019

Comparison between laparoscope and left hepatectomy in curing hepatolithiasis in terms of effect and health economics YIN Zhe. （Department of general surgery，Chengdu Western Hospital，Chengdu 610000，China）

[Abstract] Objective： To compare laparoscope and left hepatectomy in curing hepatolithiasis in terms of effect and health economics. Methods： Make a retrospective analysis of the information of patients with hepatolithiasis in the left half liver hospitalized from August， 2013 to August， 2015. Laparoscope group has 79 cased and left hepatectomygroup has 75 cases. Compare the two groups in terms of perioperative period， complication and follow-up visits and analyze the health economics of these two treatment plans. Results： Compared with control group， laparoscope group has longer operation time， and less abdominal drainage volume， use of pain killer， anal exsufflation time， out of bed time， drainage tube removal time， stitches removal time and in-hospital time. The differences were statistically significant （P<0.05）. In terms of blood loss during operation， the difference is not statistically significant（P>0.05）.The incidence of complications of laparoscope group was 7.59% while the left hepatectomy group was 39.19%. The difference is statistically significant（P<0.05）. The two group had no statistically significant differences in calculus removal rate， effect of operation， recurrence rate（P>0.05）. Cost Utility Ratio（CUR）and Increase Cost Utility Ratio （ICUR） both were lower than left hepatectomy group， representing better health economics indicators. Conclusions： Compared with left hepatectomy in curing hepatolithiasis， laparoscope can further improve recovery speed， reduce operational risk and save money apart from guaranteeing clinical effects.

[Key words] laparoscope；laparotomy；left hepatectomy；hepatolithiasis；health economics

肝内胆管结石是临床常见病，规则左半肝切除术被认为是肝内胆管结石治疗的较佳方案[1]，近年来微创技术的不断成熟，使得腹腔镜在肝内胆管结石的治疗中受到了广泛关注[2]。但有学者认为，由于肝内胆管解剖复杂，结石常分布于多个肝叶，腹腔镜手术的操作难度较高且结石清除率受限，其应用价值有待商榷[3]。本研究就腹腔镜与开腹左半肝切除治疗肝内胆管结石的疗效及卫生经济学指标进行分析，旨在明确两种方案治疗肝内胆管结石的临床价值。……