腹腔镜左半肝切除术治疗有腹部手术史的肝胆管结石患者疗效的倾向性评分匹配分析

Efficacy of laparoscopic left hemihepatectomy for hepatolithiasis patients with previous history of abdominal surgery: a propensity score matching analysis

摘要:

背景与目的 肝切除术是治疗肝胆管结石的重要方法，近年来腹腔镜肝脏切除的应用取得了长足进步。腹腔镜手术较开腹手术具有创伤小、恢复快及住院时间短等优点，但腹腔镜左半肝切除术在有腹部手术史的肝胆管结石患者中应用的临床研究较少。本研究通过回顾性分析，探讨腹腔镜左半肝切除术在有腹部手术史的肝胆管结石患者中的临床应用价值。方法 回顾性分析2017年1月—2020年12月四川省德阳市人民医院行腹腔镜左半肝切除术治疗的172例肝胆管结石患者的临床资料，使用倾向性评分匹配法（PSM）对有腹部手术史患者（观察组）和无腹部手术史患者（对照组）进行1∶1匹配。比较两组患者的相关临床指标以及随访情况。结果 匹配后，两组各43例，基线资料均衡可比。与对照组比较，观察组手术时间明显延长（225 min vs. 252 min，P<0.05），但术中出血量、中转率、术后下床时间、术后拔管时间、术后住院时间及术后总并发症发生率差异均无统计学意义（均P>0.05）；两组术后第1天肝功能指标及C反应蛋白水平差异均无统计学意义（均P>0.05）。随访中位时间为21（3~48）个月，两组的结石清除与复发情况差异无统计学意义（均P>0.05）。结论 腹腔镜左半肝切除术在有腹部手术史的肝胆管结石患者中的应用是安全、可行、有效的，虽然由于术中粘连分解的手术步骤而致手术时间延长，但并不增加其他方面的不良影响。

Abstract:

Background and Aims Hepatectomy is an important method for the treatment of hepatolithiasis. In recent years, a great progress has been made in the application of laparoscopic hepatectomy. Compared with open surgery, laparoscopic surgery has the advantages of less trauma, rapid recovery and short hospital stay. But there are few clinical studies on application of laparoscopic left hemihepatectomy in hepatolithiasis patients with a previous history of abdominal surgery. Therefore, this study was conducted to investigate the clinical application value of laparoscopic left hemihepatectomy in hepatolithiasis patients with a previous history of abdominal surgery through a retrospective analysis.Methods The clinical data of 172 patients with hepatolithiasis who underwent laparoscopic left hemihepatectomy from January 2017 to December 2020 in Deyang People's Hospital were retrospectively analyzed. The patients with previous history of abdominal surgery (observation group) and those without previous history of abdominal surgery (control group) were matched using propensity score matching (PSM) at a 1∶1 ratio. The main clinical variables and follow-up results were compared between the two groups of patients.Results There were 43 patients in each group after match, with balanced and comparable baseline data. In observation group compared with control group, the operative time was significantly prolonged (225 min vs. 252 min, P<0.05), but no significant differences were seen in intraoperative blood loss, conversion rate, time to postoperative ambulation, time to postoperative tube removal, length of postoperative hospital stay and incidence of overall postoperative complications (all P>0.05). There were no significant differences in terms of liver function parameters and C-reactive protein levels between the two groups on the first day after operation (all P>0.05). The median follow up time was 21( range 3-48) months, no significant differences were noted in stone clearance and stone recurrence between the two groups during follow-up period (both P>0.05).Conclusion Using laparoscopic left hemihepatectomy for the treatment of hepatolithiasis in patients with a previous history of abdominal surgery is safe, feasible and effective. Although the operative time will be prolonged due to the additional surgical procedures for detachment of the adhesions during operation, it will not increase the adverse impacts on other aspects.