MRI to compare the long-term outcomes of partial hepatectomy versus choledocholithotomy in the treatment of hepatolithiasis / 中华肝胆外科杂志

Objective To compare the long-term outcomes of partial hepatectomy versus choledocholithotomy both combined with choledochoscopy,for the treatment of hepatolithiasis.Methods Patients who underwent either type of the operations were followed up and examined using hepatobiliary magnetic resonance (enhanced MRI + MRCP).The incidences of abnormal imaging in the two groups were compared.Results Of 268 patients,138 patients underwent partial hepatectomy and the remaining 130 patients underwent choledocholithotomy.When hepatectomy was compared with choledocholithotomy,the recurrence rate of acute cholangitis combined with bile duct stone (5.8％ vs.21.5％),the reoperation rate (5.8％ vs.21.5％),the bile duct stricture rate (8.0％ vs.44.6％),the abnormal liver parenchyma perfusion rate (4.3％ vs.23.1％),the incidence of intrahepatic bile duct enhancement or thickening (1.5％ vs.26.9％),the incidence of hepatic atrophy (3.0％ vs.30.0％) and the incidence of cholangiocarcinoma (0 vs.2.3％) were better.Conclusions The long-term adverse outcomes were significantly worse in the choledocholithotomy group than in the partial hepatectomy group.Choledocholithotomy combined with choledochoscopy should only be considered as a complementary procedure to partial hepatectomy in hepatolithiasis.

Comparative studies of perioperative period correlation factor of hepatectomy treatment for liver malignant tumor / 中华肝胆外科杂志

Objective To compare superiorities of liver malignant tumors underwent regular and irregular hepatectomies through approaching perioperative factors.Methods 1019 consecutive hepatectomies of liver malignant tumor from 1986 to 2009 at Air Force General Hospital and General Hospital of Chinese PLA were investigated retrospectively according to their medical documentation.Results Multivariate analysis showed that liver malignant tumors on which regular hepatectomy and irregular hepatectomy were performed,there was no significant difference in the blood loss,complications,mortality related to operation,hospital stay,and so on.But the operating time of regular hepatectomy was obvious more than that of irregular hepatectomy (P＜ 0.001,OR=1.004).Conclusions Although for liver malignant tumor,regular hepatectomy seems to be superior to irregular hepatectomy based on oncological theory,in clinical practice,there were no significant difference between the perioperative risk of regular hepatectomy and that of irregular hepatectomy.

Application of selective hepatopetal blood flow occlusion for anatomic hepatectomy / 中国普通外科杂志

Objective To investigate the application of selective hepatopetal blood occlusion techniques in anatomic hepatectomy.Methods We retrospectively reviewed the clinical data of 259 patients with hepatolithiasis or liver tumor undergoing anatomic hepatectomy under selective hepatopetal blood occlusion from January 2006 to December 2009.Results Totally,183 cases with hepatolithiasis and 76 cases with liver tumor underwent anatomic hepatectomy under selective hepatopetal blood occlusion.The average intra-operation blood loss was 210 mL(120-1 600 mL);post-operation incidence of complications and the rate of residual stones was 10.9% and 4.2%,respectively.Thre was no operative death in this series.The intrahepatic recurrence and metastasis rate of liver tumor was 23.6% and the median recurrence was 16.3 months.Conclusions The use of a appropriate selective hepatopetal blood occlusion during anatomic hepatectomy for hepatolithiasis and liver tumors is an effective measure to reduce surgical complications and improve outcome.