Comparison of percutaneous transhepatic choledochoscopic lithotripsy and traditional open hepatectomy in the treatment of regional hepatolithiasis with biliary cirrhosis / 中国医师杂志

ABSTRACT

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.