ObjectiveTo explore the safety and feasibility of mixed approach laparoscopic anatomical left hepatectomy for left hepatolithiasis.MethodThe clinical data and follow-up results of 23 patients with left hepatolithiasis admitted to the Department of Hepatobiliary Pancreatic Surgery in Leshan People’s Hospital from June 2018 to June 2020 were retrospectively analyzed.ResultsAll 23 patients underwent anatomical left hepatectomy under laparoscopy. The median of total operation time was 185 min (153–460 min), the median of operation time of liver dissection was 110 min (90–125 min), the median of total blood loss during operation was 175 mL (100–800 mL), the median of blood loss from liver dissection was 120 mL (60–560 mL), blood transfusion was performed in 2 patients during operation. Postoperative day 1: median of AST was 75 U/L (32–437 U/L), median of ALT was 83 U/L (25–537 U/L),median of TBIL was 24 μmol/L (15.6–42.7 μmol/L); postoperative day 3: median of AST was 31 U/L (23–129 U/L),median of ALT was 27 U/L (14–108 U/L), median of TBIL was 13.5 μmol/L (10.4–24.3 μmol/L). Postoperative blood transfusion was performed in 1 patient, and the median of postoperative hospital stay was 7 days (5–20 days), median of postoperative extubation time was 2.5 days (2–5 days). Postoperative complications occurred in 3 patients. All 23 patients were followed up after the operation for median of 12 months (6–18 months). During the follow-up period, the patients had no special discomfort, no stone recurrence, reoperation, and death.ConclusionMixed approach laparoscopic anatomical left hepatectomy is safe and feasible in the treatment of left hepatolithiasis.
ObjectiveTo evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. MethodsClinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complications between the 2 groups were compared. ResultsCompared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients(P < 0.05), there were no significant difference in operative time and bleeding during operation of 2 groups(P > 0.05), The incidence of postoperative complications in the observation group was significantly lower than the control group(P < 0.05). In 122 patients, 105 cases were followed-up(86.1%), the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. ConclusionsBile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct incision and T tubedrainage.
目的 了解肝部分切除治疗肝内胆管结石的效果。方法回顾性分析1984年3月至1997年8月对95例肝内胆管结石施行肝部分切除，并辅以狭窄胆管切开整形及胆肠吻合等手术的治疗情况。结果 临床疗效优良者达93.7%，术后残留结石10例，残石率为10.5%。结论 肝部分切除治疗肝内胆管结石是目前较理想有效的手术方式。
ObjectiveTo investigate the feasibility and safety of subtotal hepatectomy with preservation of caudate lobe for extensive hepatolithiasis with atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.MethodThe clinicopathologic data of patient with hepatolithiasis whose left and right hepatic lobe atrophied and caudate lobe obviously hypertrophied admitted to the West China Hospital of Sichuan University in February 2020 were analyzed retrospectively.ResultsThe patient was in good general condition before the operation. The cardiopulmonary and kidney functions were normal. The liver function was Child-Pugh A grade, and the liver reserve function was good. The body surface area of the patient was 1.745 m2 and the standard liver volume was 1 235 mL. The volume of caudate lobe calculated by the 3D reconstruction of CT image was 735 mL, accounted for 59.5% of the standard liver volume. The patient was evaluated to be able to tolerate the operation. The patient successfully experienced the operation of subtotal hepatectomy with caudate lobe preservation. The postoperative liver function recovered well. The gastric tube was removed on the 4th day after the operation. The peritoneal drainage tube was removed on the 5th day after the operation. The patient was discharged on the 6th day after the operation. The postoperative pathological diagnosis: The intrahepatic bile duct was dilated with stones inside. A large number of inflammatory cell infiltrated around the bile duct. The fibrous tissue hyperplasia, small bile duct hyperplasia and inflammatory cell infiltration were observed in the portal area. The pathological changes were consistent with the changes of hepatolithiasis.ConclusionAccording to analysis results of this case, subtotal hepatectomy with preservation of caudate lobe is safe and feasible for hepatolithiasis patient with obvious atrophy of left and right hepatic lobe and obvious hypertrophy of caudate lobe.
Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
ObjectiveTo investigate the option of biliary drainage for surgical management of hepatolithias. MethodsThe clinical data of 146 patients with hepatolithiasis, who were admitted to the First Affiliated Hospital of Anhui Medical University from March 2006 to June 2014, was analyzed retrospectively.These patients were divided into biliary enteric drainage group and T tube drainage group according to the function of sphincter of Oddis.The intra-operative related data, postoperative complications, and long-term efficacy were compared between two groups. Results①The two groups were comparable in terms of gender, age, body weight, preoperative liver function, preoperative symp-toms and signs, preoperative biochemical index, calculus distribution, preoperative complications (P > 0.05).②There were no significant differences of the hepatolobectomy rate, intraoperative blood loss, intraoperative blood transfusion, times and time of hepatic portal occlusion, bile culture positive rate, hospital stay and hospitalization expenses between two groups (P > 0.05).But the operation time of the biliary enteric drainage group was significantly longer than that of the T tube drainage group (P < 0.001).③The total complications rate and specific complication rate were not signifi-cantly different between two groups (P > 0.05).④The stone instant clearance rate of the biliary enteric drainage group was significantly higher than that of the T tube drainage group (P=0.031).But the stone final clearance rate was not significantly different between two groups (P=0.841).⑤The postoperative quality of life was not significantly different between two groups (Excellent and good:P=0.560;Poor:P=0.560).The rates of stone residual, recurrence, mortality and canceration were not significantly different between two groups (P > 0.05). ConclusionThe biliary drainage for surgical management of hepatolithias is selected according to the function of sphincter of Oddi.Biliary enteric drainage and Roux-en-Y anastomosis are firstly selected for patients with the loss of function of sphincter of Oddi.
ObjectiveTo investigate the clinical application effect of descending hilar plate technology in laparoscopic heminephrectomy for intrahepatic bile duct calculus.MethodsThe clinical data of 40 patients with intrahepatic bile duct calculus who underwent laparoscopic heminephrectomy in our hospital from January 2015 to December 2019 were retrospectively analyzed. The patients were grouped according to different surgical procedures, 21 patients with Pringle method of total hepatic vascular exclusion were classified in the control group, and 19 patients with descending hilar plate technology of blood occlusion technology were classified in the observation group. The operation time, intraoperative bleeding volume, postoperative hospital stays, liver function recovery, and postoperative complications were compared between the two groups.ResultsThere was no statistically significant difference between the two groups in the intraoperative bleeding volume and operation time (P>0.05), but the postoperative hospital stays in the observation group shortened (P=0.025). The changes on the ALT, TB, and AST in the observation group was obvious than those of the control group (P<0.05). There was no statistically significant incidence between the two groups in the total incidence of complications (P=0.128).ConclusionsCompared with Pringle method of total hepatic vascular exclusion, descending hilar plate technology in laparoscopic heminephrectomy can fully expose the Glisson pedicles of the left and right livers, and it is convenient to implement hemihepatic blood flow occlusion. It has less damage to healthy side of the liver and quicker liver function recovery, and it can reduce postoperative complications and shorten postoperative hospital stay.