Clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis / 中华消化外科杂志

ABSTRACT

Objective:To investigate the clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 122 patients with diffuse hepatolithiasis who were admitted to Hunan Provincial People's Hospital from January 2010 to December 2015 were collected. There were 39 males and 83 females, aged from 21 to 82 years, with a median age of 51 years. After perihilar hepatectomy, the first, second and third divisions of hepatic ducts were opened longitudinally. Strictures in the bile ducts were relieved by stricturoplasty and internal bile duct anastomosis, and stones were removed by multiple methods under direct vision. After resection of severe atrophic liver segment along the plane of hepatic atrophy or bile duct stricture, T-tube or hepaticojejunos-tomy was used for internal drainage. Observation indicators (1) surgical situations; (2) stricture relief and stone removal. (3) Follow-up. Follow-up was conducted by Wechat, telephone interview or outpatient examination. Patients were followed up once every 3 months in the postoperative 1 year through liver function and abdominal B-ultrasound examination. Subsequently, liver function and abdominal B-ultrasound were reexamined once a year. Magnetic resonance cholangiopancreato-graphy and computed tomography were performed when cholangitis or stone recurrence was suspected to analyze stone recurrence and patient survival. The follow-up was up to July 2020. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Results:(1) Surgical situations for the 122 patients, the operation time, hepatic portal occlusion time, volume of intraoperative blood loss, duration of postoperative hospital stay were (253±71)minutes, 15 minutes(range, 14?38 minutes), 200 mL(range, 100?1 100 mL), (12±5)days. Postoperative complications occurred to 40 of 122 patients. There were 9 cases of incision infection, 8 cases of bile leakage (5 cases of bile leakage at hepatic section, 3 cases of choledochojejunostomy leakage), 8 cases of septicemia, 7 cases of pleural effusion, 5 cases of abdominal abscess, 3 cases of liver failure, 1 case of biliary bleeding. Some patients had multiple complications. Among the 122 patients, 2 cases died after operation, including 1 case of postoperative liver failure and 1 case of disseminated intravascular coagulation caused by biliary-intestinal anastomotic leakage complicated with sepsis. Patients with bile leakage and abdominal abscess were improved after puncture and drainage under the guidance of B-ultrasound. Patients with cholangiojejunal anastomotic bleeding were embolized through the right hepatic artery. The other complications were improved after conservative treatment. (2) Stricture relief and stone removal 85 of 88 patients with biliary stricture were relieved, with the stricture relief rate of 96.59%(85/88). Among the 122 patients, 103 cases had stones completely removed and 19 cases had residual stones. The immediate stone clearance rate was 84.43%(103/122). Of the 19 patients with residual stones, choledochoscopy was refused in 3 cases and choledochoscope lithotripsy was performed in 16 cases, of which 7 cases were removed and 9 cases were still residual stones. Of the 122 patients, 110 cases were finally removed stones, 12 cases were eventually residual stones, and the final stone clearance rate was 90.16%(110/122). (3) Follow-up among the 122 patients, 120 cases including 110 cases with find stone removal and 10 cases with residual stones were followed up for (78±14)months. The 1-, 3, 5-year stone recurrence rates of 120 patients were 0.83%(1/120), 6.67%(8/120), 9.17%(11/120), respectively. The 1-, 3-, 5-year stone recurrence rates of 110 patients with final stone removal were 0, 5.45%(6/110), 5.45%(6/110), respectively. The number of cases with stone recurrence at postoperative 1-, 3- and 5-year of 10 patients with residual stones were 1, 2, 5 cases, respectively. Of 120 patients with follow-up, 1 case died of end-stage liver disease, and the other patients had good survival.Conclusion:Perihilar surgical techniques for diffuse hepatolithiasis is safe and effective.