Clinical study on curative effect of surgical treatment for hepatolithiasis

LI Xiaogui; WUYi; LU Jiayin; LI Hao; WANG Xintian

PDF(2597 KB)

Journal of Hunan Normal University(Medical Science) ›› 2024, Vol. 21 ›› Issue (1) : 75-80.

Clinical Medicine

Clinical study on curative effect of surgical treatment for hepatolithiasis

LI Xiaogui, WUYi, LU Jiayin, LI Hao, WANG Xintian

Author information +

History +

Abstract

Objective To investigate the surgical treatment of hepatolithiasis. Methods Retrospective analysis and summary were made of 658 cases of hepatolithiasis treated by our department of surgery from January 2019 to July 2022, and the characteristics of the cases and surgical methods were analyzed . Results Among the 658 cases, 306 cases (46.50%) underwent hepatic lobectomy, among which laparoscopic hepatic lobectomy accounted for 13.7%; biliary and intestinal drainage accounted for 52.58%; holmium laser accounted for 46.20%; percutaneous hepatic bile duct lithotripsy (percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) accounted for 6.69%. There was 1 death in the whole group, and 196 patients (29.79%) were found to have residual stones in postoperative CT scans, of which 63 patients (9.57%) underwent choledochoscopy for stone removal.19cases (2.89%) of complicated biliary tract infection occurred after operation, of which 2 case (0.31%) died after multiple organ failure due to severe infection, and the remaining 17 cases ( (2.58%) were treated with repeated bile culture to adjust antibiotics and other symptomatic cases improved after supportive treatment. There were 52 cases (7.90%) of postoperative bile leakage, all of which were self-limited after nutritional support therapy or ultrasound-guided intraperitoneal drainage. There were 50 cases (7.60%) of postoperative hemorrhage, of which 4 cases (0.61%) underwent laparotomy for hemostasis, 3 cases (0.46%) underwent interventional embolization for hemostasis, and the rest stopped bleeding after conservative treatment. Conclusion The disease of hepatolithiasis is complicated and personalized, which requires multi-departmental collaboration and combination of a variety of advanced technologies to formulate “individual” treatment plan for specific cases.

Key words

hepatolithiasis / treatment options / microtrauma operation

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

LI Xiaogui, WUYi, LU Jiayin, LI Hao, WANG Xintian. Clinical study on curative effect of surgical treatment for hepatolithiasis[J]. Journal of Hunan Normal University(Medical Science). 2024, 21(1): 75-80

References

[1] 董家鸿, 郑树国, 陈平, 等. 肝胆管结石病诊断治疗指南[J]. 中华消化外科杂志, 2007(02): 156-161.
[2] 朱斯维, 尹新民. 肝胆管结石腔镜手术的决策与要点[J]. 肝胆外科杂志, 2021, 29(02): 81-83+122.
[3] 陈晨, 王蕾, 汪新天, 等. 输尿管硬镜联合钬激光在肝胆管结石合并胆汁性肝硬化疾病中的应用[J]. 中国医师杂志, 2021, 23(10): 1506-1509.
[4] 郭仁宣, 李捷雷, 沈魁, 等. 肝胆管结石的临床特征 (附182例分析)[J]. 实用外科杂志, 1988(05): 247-249.
[5] MIYAZAKI T, SHINKAWA H, TAKEMURA S, et al.Precancerous Lesions and Liver Atrophy as Risk Factors for Hepatolithiasis-Related Death after Liver Resection for Hepatolithiasis[J]. Asian Pac J Cancer Prev, 2020, 21(12): 3647-3654.
[6] 耿小平. 基于临床分型的肝胆管结石病治疗策略[J]. 中华消化外科杂志, 2020, 19(08): 804-807.
[7] 黄振驹, 胡浩宇, 曾思略, 等. 三维可视化联合吲哚菁绿分子荧光影像技术在复杂性肝胆管结石诊疗中应用研究[J]. 中国实用外科杂志, 2023, 43(01): 108-113.
[8] FANG C, AN J, BRUNO A, et al.Consensus recommendations of three-dimensional visualization for diagnosis and management of liver diseases[J]. Hepatol Int, 2020, 14(4): 437-453.
[9] 张浩鹏, 张新亚. 腹腔镜肝切除治疗左肝内胆管结石的临床研究[J]. 肝胆外科杂志, 2022, 30(02): 134-137.
[10] 叶永青, 王平, 龚靖霖. 肝胆管结石病合并胆管狭窄的外科治疗进展[J]. 中华肝胆外科杂志, 2022, 28(05): 392-396.
[11] 陈志宇. 精准肝胆外科技术体系在复杂肝胆管结石病中的应用[J]. 中华消化外科杂志, 2021, 20(08): 869-875.
[12] 李佳, 李国光, 胡脉涛, 等. 围肝门外科技术治疗弥漫型肝胆管结石病的临床疗效[J]. 中华消化外科杂志, 2021, 20(08): 883-889.
[13] 何翔宇, 周杰, 尹新民, 等. 腹腔镜与开放胆肠内引流重建术治疗胆肠吻合口狭窄安全性与近期疗效观察: 一项倾向性评分匹配研究[J]. 中国实用外科杂志, 2022, 42(09): 1010-1015.
[14] 林益坤, 谢朗, 符剑鸣, 等. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析[J]. 实用肝脏病杂志, 2022, 25(04): 591-594.
[15] 中国研究型医院学会肝胆胰外科专业委员会. 肝胆管结石病经皮经肝取石手术应用指南 (2021版)[J]. 中华肝胆外科杂志, 2022, 28(01): 7-14.
[16] 彭江, 连博达, 汪新天, 等. 经皮肝胆道造瘘碎石取石术与传统开腹肝段切除术对区域性肝胆管结石合并胆汁性肝硬化的治疗效果对比[J]. 中国医师杂志, 2023, 25(02): 192-195+201.
[17] 安伟, 张锎, 冯宪光, 等. 胆道镜下球囊扩张取石术治疗肝内胆管结石合并胆管良性狭窄的疗效分析[J]. 中国现代普通外科进展, 2021, 24(8): 626-629.
[18] 刘双, 周敬强, 杨士明, 等. PTOBF联合分步胆道镜治疗胆肠吻合术后Ⅰ型和Ⅱa型肝胆管结石的研究[J]. 中华肝胆外科杂志, 2022, 28(03): 171-175.
[19] 赵红川. 肝移植治疗终末期肝胆管结石病[J]. 肝胆外科杂志, 2021, 29(02): 154-155.
[20] 董家鸿, 叶晟. 我国肝胆管结石病治疗理念及模式的变迁[J]. 中国实用外科杂志, 2016, 36(03): 261-263.
[21] FENG LB, XIA D, YAN LN.Liver transplantation for hepatolithiasis: Is terminal hepatolithiasis suitable for liver transplantation?[J]. Clin Transplant, 2016, 30(6): 651-658.
[22] 颜锡洋, 陈江明, 李贺, 等. 胆道良性疾病行胆管空肠吻合术后并发症的危险因素分析[J]. 中华普通外科杂志, 2022, 37(10): 761-765.
[23] 刘飞, 李海, 巫强. 无胆道重建肝切除术后胆漏危险因素的Meta分析[J]. 临床肝胆病杂志, 2022, 38(03): 594-600.
[24] 陈龙, 李钺. 肝切除术后并发症的危险因素及预测评分系统[J]. 临床肝胆病杂志, 2019, 35(01): 217-221.
[25] YAMASHITA YI, YAMAMOTO H, MIYATA H, et al.Risk factors for bile leakage: Latest analysis of 10 102 hepatectomies for hepatocellular carcinoma from the Japanese national clinical database[J]. J Hepatobiliary Pancreat Sci, 2021, 28(7): 556-562.
[26] KULKARNI AV, PREMKUMAR M, ARAB JP, et al.Early Diagnosis and Prevention of Infections in Cirrhosis[J]. Semin Liver Dis, 2022, 42(3): 293-312.