Objective: To compare the safety and efficacy of laparoscopic and open hepatectomy for hepatolithiasis. Methods: Between January 2014 and May 2020, the clinicopathological data of 254 patients with hepatolithiasis who underwent laparoscopic or open hepatectomy at the First Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College were collected retrospectively. There were 74 males and 180 females with age of (56±8) years (range: 38 to 77 years). Of the 254 patients, 162 underwent laparoscopic surgery (laparoscopic group) and 92 underwent open surgery (open group). Propensity score matching(PSM) was performed to match baseline characteristics of the two groups,and then the perioperative results and follow-up efficacy were compared between the two groups. The t-test, Mann-Whitney U test, χ2 test or Fisher's exact probability method was used to compare the perioperative data and follow-up results of the two groups after matching, respectively. Results: Each group had 63 patients after PSM with well-balanced baseline characteristics. There was no statistic difference in the type of hepatectomy,combined common bile duct exploration rate,T tube drainage placement rate,operation time,intraoperative transfusion rate,intraoperative accidental injury rate,initial and final stone clearance rate,and stone recurrence rate between the two groups. However,compared with the open hepatectomy group, the laparoscopic group had significantly lower intraoperative blood loss (M(IQR))(300(175)ml vs. 350(145)ml, Z=3.227,P=0.001),shorter postoperative hospital stay((10.6±4.1)days vs. (14.0±4.0)days,t=4.634,P<0.01),shorter time to postoperative oral intake ((1.8±1.1)days vs. (2.9±1.6)days, t=4.556, P<0.01), and lower postoperative complication rate (25.4%(16/63) vs. 49.2%(31/63), χ²=7.635, P=0.006). Conclusion: Laparoscopic hepatectomy is safe and effective for hepatolithiasis with the advantages of less intraoperative blood loss,lower postoperative complications and faster postoperative recovery.
目的： 比较腹腔镜和开腹肝切除术治疗肝内胆管结石的安全性和效果。 方法： 回顾性收集2014年1月至2020年5月在川北医学院附属医院肝胆外一科接受腹腔镜或开腹肝切除手术治疗的254例肝内胆管结石患者的临床和病理学资料。男性74例，女性180例，年龄（56±8）岁（范围：38~77岁）。其中接受腹腔镜手术162 例（腹腔镜组），接受开腹手术92例（开腹组）。采用倾向性评分匹配对两组患者的基本资料进行1∶1匹配。分别采用t检验、Mann-Whitney U检验、χ²检验或Fisher确切概率法比较匹配后两组患者的围手术期数据及随访资料。 结果： 腹腔镜组和开腹组各有63例匹配成功，匹配后两组的基线特征保持平衡。匹配后两组患者肝切除类型、联合胆总管探查比例、T管引流比例、手术时间、术中输血比例、术中意外损伤、初次和最终结石清除率、结石复发率的差异均无统计学意义（P值均>0.05）。腹腔镜组患者术中出血量［M（IQR）］［300（175）ml比350（145）ml，Z=3.227，P=0.001］、术后住院时间［（10.6±4.1）d比（14.0±4.0）d，t=4.634，P<0.01］、术后进食时间［（1.8±1.1）d比（2.9±1.6）d，t=4.556，P<0.01］、术后并发症发生率［25.4%（16/63）比49.2%（31/63），χ²=7.635，P=0.006］均优于开腹组，差异均有统计学意义。 结论： 腹腔镜肝切除术治疗肝内胆管结石较为安全有效，与开腹手术相比，具有出血量少、术后并发症发生率低和术后恢复快的优点。.