Laparoscopic left lateral lobectomy combined with choledocholithotomy in treatment of intrahepatic and extrahepatic bile duct stones

doi:10.3877/cma.j.issn.2095-3232.2021.04.010

Abstract

Abstract:

Objective

To evaluate the clinical efficacy of laparoscopic left lateral lobectomy combined with choledocholithotomy in the treatment of intrahepatic and extrahepatic bile duct stones.

Methods

Clinical data of 186 patients with bile duct stones located in the left lobe and common bile duct admitted to Zhongshan Hospital Affiliated to Sun Yat-sen University from January 2013 to October 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 71 patients were male and 115 female, aged from 33 to 82 years with a median age of 52 years. According to different surgical methods, all patients were divided into the laparoscopic group (n=104) and open group (n=82). The perioperative conditions and incidence of postoperative complications were compared between two groups. The operation time and intraoperative blood loss were statistically compared between two groups by t test. The incidence of postoperative complications was compared by Chi-square test.

Results

The average operation time in laparoscopic group was (258±26) min, significantly longer than (212±32) min in the open group (t=3.512, P<0.05). In laparoscopic group, the intraoperative blood loss, postoperative fasting time, postoperativeout-off-bed time and length of postoperative hospital stay were (182±14) ml, (1.3±0.6) d, (2.3±0.4) d and (8.5±2.3) d, significantly less than (260±15) ml, (3.4±0.4) d, (4.2±0.5) d and (12.5±2.7) d in open group(t=-1.894, -2.767, -1.724, -4.156; P<0.05), respectively. In laparoscopic group, 5 cases developed residual stones and 4 cases in open group, where no significant difference was observed (χ²=0.125, P>0.05). In laparoscopic group, 1 case suffered from postoperative incisional infection, significantly differing from5 cases in open group (χ²=3.972, P<0.05).

Conclusions

Laparoscopic left lateral lobectomy combined with choledocholithotomy yields mild trauma, rapid recovery and high safety in the treatment of intrahepatic and extrahepatic bile duct stones, which can achieve equivalent clinical efficacy to open surgery.

Key words: Cholelithiasis, Laparoscopes, Hepatectomy, Treatment outcome

Yuqiang Wu, Zaiping Zhou, Zemin Hu, Qiang Sun. Laparoscopic left lateral lobectomy combined with choledocholithotomy in treatment of intrahepatic and extrahepatic bile duct stones[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(04): 386-389.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2021.04.010

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2021/V10/I04/386

Figures/Tables 3

References 21

[1]	中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜治疗肝胆管结石病的专家共识(2013版)[J]. 中华消化外科杂志, 2013, 12(1):1-5.
[2]	崔金华，李剑，刘亚曼, 等. 腹腔镜与开腹左半肝切除治疗肝内胆管结石的对比研究[J].承德医学院学报, 2020, 37(3):192-194.
[3]	赵义军，耿小平. 复杂肝内胆管结石的治疗[J]. 肝胆外科杂志, 2018, 26(1):71-73.
[4]	Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma[J]. Hepatology, 2011, 54(1):173-184.
[5]	Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center[J]. Surgery, 2018, 163(4):714-720.
[6]	尹新民，朱斯维. 腹腔镜肝切除术的进展[J]. 中国普外基础与临床杂志, 2019, 26(2):129-132.
[7]	杜顺达，金保，毛一雷. 腹腔镜肝切除术的规范化问题[J]. 中国普外基础与临床杂志, 2019, 26(2):133-136.
[8]	Zeng X, Yang P, Wang W. Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?:a single-center retrospective case-control study[J]. Medicine, 2018, 97(46):e13080.
[9]	王金宝，谭庆娟，王维山, 等. 腹腔镜肝段切除术治疗左肝胆管结石的随机对照研究[J].腹腔镜外科杂志, 2019, 24(5):356-359.
[10]	胥丹，朱春燕，韩保俊, 等. 腹腔镜下不同左肝切除方式治疗左肝胆管结石的对比研究[J]. 肝胆胰外科杂志, 2020, 32(7):408-414.
[11]	陈熙，胡朝辉，彭永海, 等. 腹腔镜左半肝切除术治疗复发性肝内胆管结石的疗效分析[J]. 腹腔镜外科杂志, 2018, 23(2):85-90.
[12]	贺德龙，周为，薛长梅, 等. 完全腹腔镜下规则性左肝切除术治疗左肝胆管结石的临床研究[J/CD]. 中华普外科手术学杂志(电子版), 2018, 12(5):448-450.
[13]	殷晓煜. 肝胆管结石的规范化手术治疗[J/CD]. 中华普通外科学文献(电子版), 2015, 9(4):259-260.
[14]	陈文哲，肖强. 左肝外叶切除术联合胆道镜治疗左肝内胆管结石34例[J]. 深圳中西医结合杂志, 2018, 28(10):125-127.
[15]	李越华，魏东，王琨, 等. 腹腔镜与开腹左肝外叶切除联合胆道镜取石治疗左肝内胆管结石的疗效比较[J]. 中国普通外科杂志, 2015, 24(8):1070-1076．
[16]	张清亮. 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[J]. 湖南师范大学学报(医学版), 2017, 14(4): 164-166.
[17]	吴涌宏，李旭刚，张耀明. 腹腔镜和开腹左半肝切除治疗左肝内胆管结石的临床疗效比较[J]. 泰山医学院学报, 2018, 39(1):55-56.
[18]	王坚. 肝胆管结石诊治的难点与对策[J]. 中华消化杂志, 2019, 39(10):657-660.
[19]	程光辉，白剑，谢开汉, 等. 肝胆外科手术并发胆汁漏的原因及防治[J]. 中国现代普通外科进展, 2012, 15(9):748, 756.
[20]	邹奇，陈杰，胡梦文, 等. 腹腔镜联合胆道镜治疗肝内胆管结石合并胆总管结石疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2020, 9(1):50-53.
[21]	罗华，曾新桃，胡朝辉, 等. 腹腔镜肝切除术在复杂肝内胆管结石患者中的应用[J]. 中国普外基础与临床杂志, 2020, 27(6):666-670.

组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		基础病（例）		腹部手术史（例）
组别	例数	年龄（岁，±s）	男	女	A级	B级	无	有	无	有
腔镜组	104	50±5	38	66	96	8	87	17	98	6
开腹组	82	51±5	33	49	75	7	69	13	71	11
统计值		t=-0.285	χ²=0.014		χ²=0.052		χ²=0.062		χ²=0.073
P值		0.514	0.842		0.821		0.712		0.683

组别	例数	年龄（岁，±s）	性别（例）		Child-Pugh分级（例）		基础病（例）		腹部手术史（例）
组别	例数	年龄（岁，±s）	男	女	A级	B级	无	有	无	有
腔镜组	104	50±5	38	66	96	8	87	17	98	6
开腹组	82	51±5	33	49	75	7	69	13	71	11
统计值		t=-0.285	χ²=0.014		χ²=0.052		χ²=0.062		χ²=0.073
P值		0.514	0.842		0.821		0.712		0.683

组别	例数	手术时间（min）	术中出血量（ml）	禁食时间（d）	术后下床时间（d）	肛门排气时间（d）	腹腔引流管时间（d）	术后住院时间（d）
腔镜组	104	258±26	182±14	1.3±0.6	2.3±0.4	2.5±0.5	6.3±2.7	8.5±2.3
开腹组	82	212±32	260±15	3.4±0.4	4.2±0.5	3.6±0.6	6.8±2.1	12.5±2.7
t值		3.512	-1.894	-2.767	-1.724	-3.805	-1.782	-4.156
P值		0.018	0.006 7	0.000	0.000	0.000	0.094	0.000

组别	例数	手术时间（min）	术中出血量（ml）	禁食时间（d）	术后下床时间（d）	肛门排气时间（d）	腹腔引流管时间（d）	术后住院时间（d）
腔镜组	104	258±26	182±14	1.3±0.6	2.3±0.4	2.5±0.5	6.3±2.7	8.5±2.3
开腹组	82	212±32	260±15	3.4±0.4	4.2±0.5	3.6±0.6	6.8±2.1	12.5±2.7
t值		3.512	-1.894	-2.767	-1.724	-3.805	-1.782	-4.156
P值		0.018	0.006 7	0.000	0.000	0.000	0.094	0.000

组别	例数	胆漏	肺部感染	切口感染	腹腔出血	术后住院时间>30 d	结石残留
腔镜组	104	5	1	1	1	1	5
开腹组	82	5	2	5	3	3	4
χ²值		0.121	0.134	3.972	0.826	0.826	0.125
P值		0.712	0.651	0.048	0.354	0.354	0.713

Please choose a citation manager

Content to export