损伤控制理念下腹腔镜肝左叶切除术治疗肝左叶胆管结石的价值

The value of laparoscopic left hepatectomy in light of damage control concept for treating left-sided hepatolithiasis

摘要:

目的 探讨损伤控制理念下腹腔镜肝左叶切除术治疗肝左叶胆管结石的临床疗效。方法 选取2018年1月—2021年1月萍乡市人民医院收治的肝左叶胆管结石患者142例。将患者分为对照组和观察组，每组71例。对照组和观察组分别给予开腹肝左叶切除术、损伤控制理念下腹腔镜肝左叶切除术，随访12个月。比较两组患者围术期相关指标、血清生化指标、术后并发症发生率、结石清除率、残留率、复发率及再次手术率。结果 观察组手术时间长于对照组，术后下床活动时间、术后进食时间、术后拔管时间和住院时间短于对照组（P <0.05）。观察组术后1 d与术后4 d谷丙转氨酶、谷草转氨酶、白细胞计数的差值低于对照组，总胆红素、直接胆红素和骨髓原始细胞非红细胞计数的差值高于对照组（P <0.05）。观察组术后并发症发生率低于对照组（P <0.05）。两组患者结石清除率、结石残留率、结石复发率、再次手术率比较，差异无统计学意义（P >0.05）。结论 损伤控制理念下腹腔镜肝左叶切除术治疗肝左叶胆管结石安全有效，创伤小，术后恢复快，可能与诱发的氧化应激和炎症反应较轻有关。

Abstract:

Objective To investigate the clinical efficacy of laparoscopic left hepatectomy in light of damage control concept for treating left-sided hepatolithiasis.Methods A total of 142 patients with left-sided hepatolithiasis admitted to our hospital between January 2018 and January 2021 were selected and divided into the control group and the observation group, with 71 cases in each group. The control group was treated with open surgery, while the observation group received laparoscopic left lobectomy in light of damage control. All the patients were followed up for 12 months. The perioperative conditions, serum biochemical indicators, incidence of postoperative complications, the stone clearance rate, the residual stone rate, the recurrence rate and the reoperation rate were compared between the two groups.Results The operative duration in the observation group was longer than that in the control group (P < 0.05), whereas the time to postoperative off-bed activities, time to postoperative feeding, time to postoperative extubation and the duration of hospitalization in the observation group were shorter than those in the control group (P < 0.05). The differences of serum ALT, AST and WBC before and after the operation in the observation group were lower than those in the control group (P < 0.05), and the changes of TBIL, DBIL and NEC after the operation were higher in the observation group than those in the control group (P < 0.05). The incidence of postoperative complications in the observation group was lower than that in the control group (P < 0.05). There was no significant difference in the stone clearance rate, the residual stone rate, the recurrence rate or the reoperation rate between the two groups (P > 0.05).Conclusions Laparoscopic left hepatectomy in light of damage control concept is safe and effective for treating left-sided hepatolithiasis with little trauma and enhanced postoperative recovery. It may be related to the mild oxidative stress and inflammatory response as well as minor liver damage.