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Objective:To compare the therapeutic effects of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) and traditional open hepatectomy (OH) on regional hepatolithiasis with biliary cirrhosis.Methods:From January 2020 to August 2022, 110 cases of regional hepatolithiasis complicated with biliary cirrhosis treated in the hepatology department of Hunan Provincial People′s Hospital were retrospectively collected. According to the surgical methods of treating hepatolithiasis, the patients were divided into minimally invasive group and laparotomy group. The minimally invasive group received PTCSL, and the laparotomy group received OH. The clinical data of the two groups were compared and analyzed, and the postoperative exhaust time, gastrointestinal function recovery time, operation time and intraoperative bleeding volume were observed. The levels of alanine aminotransferase (ALT), γ-glutamyltransferase(GGT) and aspartate aminotransferase (AST) before and after operation were compared between the two groups. The incidence of complications and stone removal rate of the two groups were recorded.Results:The postoperative exhaust time (11.12±2.09)h, gastrointestinal function recovery time (25.76±4.28)h, operation time (108.51±16.19)h, intraoperative blood loss (20.16±3.59)ml and postoperative exhaust time (29.35±4.83)h and gastrointestinal function recovery time in the minimally invasive group were less than those in the laparotomy group (36.91±6.35)h, operation time (116.27±21.54)h and intraoperative blood loss (38.03±6.22)ml (all P<0.05). The levels of ALT (77.82±16.25)U/L, GGT (248.16±24.83)U/L and AST (65.42±16.82)U/L in the minimally invasive group after operation were lower than those in the laparotomy group [ALT (102.37±25.64)U/L, GGT (345.45±32.60)U/L and AST (96.30±22.17)U/L] (all P<0.05). The incidence of postoperative complications was 7.27%(4/55) in the minimally invasive group and that in the laparotomy group was 29.09%(16/55), with statistically significant difference ( P<0.05). The stone removal rate was 61.82%(34/55) in the minimally invasive group and 92.73%(51/55) in the laparotomy group, with statistically significant difference ( P<0.05). Conclusions:PTCSL and OH are effective in the treatment of regional hepatolithiasis complicated with biliary cirrhosis. The traditional OH has a high stone removal rate, and PTCSL has little influence on liver function, small complication rate and fast postoperative recovery.
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Objective:To discuss the clinical value and significance of real-time ultrasound-guided anatomical segmental hepatectomy in patients with primary liver cancer.Methods:43 patients with primary liver cancer treated in Hunan Provincial People′s Hospital from January 2015 to October 2017 were retrospectively selected as the control group, and 43 patients with primary liver cancer treated from November 2017 to December 2019 were selected as the observation group. The control group was treated with irregular hepatectomy, and the observation group was treated with anatomical segmental hepatectomy under real-time ultrasound navigation. The operation, postoperative complication rate and quality of life score were compared between the two groups after different treatment.Results:The portal occlusion rate and blood transfusion rate of the observation group (13.9%, 9.3%) were significantly lower than those of the control group (30.2%, 25.5%; all P<0.05); the operation time of the observation group [(153.4±14.20)min] was significantly longer than that of the control group [(127.3±12.10)min, P<0.05]; one year after operation, the recurrence rate of the observation group (9.3%) was significantly lower than that of the control group (30.2%, P<0.05), and the survival rate (81.4%) was significantly higher than that of the control group (51.2%, P<0.05). Conclusions:The application of real-time ultrasound-guided anatomical segmental hepatectomy in patients with primary liver cancer can significantly reduce the porta hepatis block rate and blood transfusion rate. It is of positive and important significance to promote the recovery of postoperative liver function, improve the quality of life and reduce the probability of disease recurrence.
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Objective:To explore the application of ureteroscope combined with holmium laser in patients with hepatolithiasis complicated with biliary cirrhosis.Methods:The clinical data of 89 patients with hepatolithiasis complicated with biliary cirrhosis treated in the hepatobiliary department of Hunan Provincial People's Hospital from February 2014 to December 2019 were collected and divided into two groups: group A was routine operation group and group B was ureteroscopy and holmium laser technology group. The clinical data of the two groups were compared and analyzed respectively.Results:The operation time in group B was less than that in group A [ (302.6±96.7)min vs (349.2±105.6)min, P<0.05], with statistically significant difference; The amount of intraoperative bleeding in group B was less than that in group A [(227.0±197.3)ml vs (331.4 ± 277.3)ml, P<0.05], with statistically significant difference; The postoperative hospital stay in group B was shorter than that in group A[(11.5±4.1)d vs (13.8±5.1)d, P<0.05], with statistically significant difference; The incidence of postoperative complications in group B was lower than that in group A (2.44% vs 18.75%, P<0.05), with statistically significant difference. The liver resection rate in group B was lower than that in group A (29.27% vs 52.08%, P<0.05). Conclusions:Through the establishment of a reasonable access to the liver, the application of ureteroscope and holmium laser technology in patients with hepatolithiasis complicated with biliary cirrhosis can achieve better diagnosis and treatment results, and this technology can be gradually promoted and applied in the clinic.
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Objective:To analysis the application value of rigid ureteroscope combined with holmium laser in diagnosis and treatment of complicated hepatolithiasis guided by three-dimensional visualization technology.Methods:50 patients with complex hepatolithiasis treated in Hunan People′s Hospital from October 2016 to March 2019 were selected as the study subjects. They were divided into observation group and control group by simple random method. 20 cases underwent rigid ureteroscope combined with holmium laser under the guidance of three-dimensional visualization technology were taken as observation group, 30 cases underwent rigid ureteroscope combined with holmium laser by traditional imaging diagnosis were taken as control group. The differences between the two groups in operation time, intraoperative bleeding volume, stone residual rate, postoperative hospital stay and postoperative complications were statistically analyzed.Results:The residual rate of calculi in observation group was 10% (2/20), while it was 40% (12/30) in control group; the amount of bleeding during operation in the observation group was (170.9±18.0)ml, and it was (371.6±37.0)ml in the control group; the operation time of observation group was (179.0±14.3)minutes, and it was (340.2±24.3)minutes in the control group; the postoperative hospital stay of observation group was (8.3±1.5)days, and it was (10.1±1.8)days in the control group; postoperative biliary hemorrhage occurred in 1 cases of the observation group, biliary tract leakage occurred in 2 cases, postoperative biliary hemorrhage occurred in 3 cases of the control group, biliary tract leakage occurred in 4 cases.Conclusions:Rigid ureteroscope combined with holmium laser guided by three-dimensional visualization technology can further improve the clinical efficacy in the diagnosis and treatment of complex hepatolithiasis. which is worthy of clinical application.
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Objective To explore the classification and surgical management of pancreatic duct stones.Methods The clinical data of 54 patients with pancreatic duct stones who were admitted to the People's Hospital of Hunan Province from June 1994 to November 2009 were retrospectively analyzed. Stones were found in the head of the pancreas (type Ⅰ ) in 31 patients, in the body and tail of the pancreas (type Ⅱ ) in 7 patients, and in all the pancreas (type Ⅲ ) in 16 patients. According to the types of the pancreatic duct stones, ten patients (6 with type Ⅰ , two with type Ⅱ and two with type Ⅲ pancreatic duct stones) received opening of the main pancreatic duct + pancreaticojejunostomy or pancreaticogastrostomy ( group A). Twenty-four patients ( 16 with type Ⅰ and eight with type Ⅲ pancreatic duct stones) received pancreaticoduodenectomy (group B). Fifteen patients (nine with type Ⅰ and six with type Ⅱ pancreatic duct stones) received subtotal resection of pancreatic head preserving duodenum (group C). Five patients with type Ⅱ pancreatic duct stones received resection of the body and tail of the pancreas and the spleen (group D). All data were analyzed using the t test. Results The mean operation time, blood loss, length of postoperative stay and hospital charges of group A were (2.2 ± 1.2)hours,( 127 ±24)ml,( 11.4 ±4.3) days and (3.24 ± 1.15 ) × 104 yuan, respectively. Five out of nine patients who were followed up had stone recurrence. The mean operation time, blood loss, length of postoperative stay and hospital charges of group B were (7.6 ± 1.1 ) hours, (409 ± 37 ) ml, ( 18.9 ± 2.5 ) days and (7.93 ± 1.35 ) × 104 yuan, respectively.No stone recurrence was detected in the 21 patients who were followed up. The mean operation time, blood loss,length of postoperative stay and hospital charges of group C were (4. 1 ± 0.7 ) hours, ( 156 ± 63 ) ml, ( 10.3 ±2.1 )days and (4. 12 ± 1.22) × 104 yuan, respectively. No stone recurrence was detected in the 15 patients who were followed up. The mean operation time, blood loss, length of postoperative stay and hospital charges of group D were (3.3 ± 1.4) hours, ( 185 ± 36 ) ml, ( 9.3 ± 2.0) days and ( 3.22 ± 1.05 ) × 104 yuan, respectively. No complication was detected after the operation, and no stone recurrence was detected in the three patients who were followed up. There were significant differences in the mean operation time, blood loss, length of postoperative stay and hospital charges between patients with type Ⅰ and Ⅲ pancreatic duct stones who received pancreaticoduodenectomy and subtotal resection of pancreatic head preserving duodenum (t = 12. 143, 14. 099, 11. 550, 9. 103,P < 0.05 ). Conclusions Classification of the pancreatic duct stones is important for choosing the proper surgical procedure. Subtotal resection of pancreatic head preserving duodenum is ideal for the treatment of patients with type Ⅰ or Ⅱ pancreatic duct stones.