Application of laparoscopic hepatectomy in patients with complex hepatolithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LUO Hua , ZENG Xintao , HU Zhaohui , CHEN Xi ,  YANG Pei , KUANG Ming , DENG Lan , HU Junchao , CHEN Sirui , PENG Yonghai , ZHANG Wei , JIANG Ting

Department of Hepatobiliary Surgery, Mianyang Central Hospital, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

YANG Pei, Email: 305827337@qq.com

Keywords：

complex hepatolithiasis; laparoscopic hepatectomy; effect

DOI：

10.7507/1007-9424.202004085

Video：

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Objective To explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.Methods The clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.Results Two cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).Conclusion Laparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.

Citation： LUO Hua, ZENG Xintao, HU Zhaohui, CHEN Xi, YANG Pei, KUANG Ming, DENG Lan, HU Junchao, CHEN Sirui, PENG Yonghai, ZHANG Wei, JIANG Ting. Application of laparoscopic hepatectomy in patients with complex hepatolithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 666-670. doi: 10.7507/1007-9424.202004085 Copy

1.	中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜治疗肝胆管结石病的专家共识(2013 版). 中华消化外科杂志, 2013, 12(1): 1-5.
2.	Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology, 2011, 54(1): 173-184.
3.	修典荣, 彭颖. 复杂胆道结石的外科治疗进展. 中华普通外科杂志, 2014, 29(7): 489-490.
4.	尹新民, 朱斯维. 腹腔镜肝切除术的进展. 中国普外基础与临床杂志, 2019, 26(2): 129-132.
5.	杜顺达, 金保, 毛一雷. 腹腔镜肝切除术的规范化问题. 中国普外基础与临床杂志, 2019, 26(2): 133-136.
6.	Zeng X, Yang P, Wang W. Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?: a single-center retrospective case-control study. Medicine (Baltimore), 2018, 97(46): e13080.
7.	Breitenstein S, DeOliveira ML, Raptis DA, et al. Novel and simple preoperative score predicting complications after liver resection in noncirrhotic patients. Ann Surg, 2010, 252(5): 726-734.
8.	李东华, 陈孝平. 肝内胆管结石的外科治疗. 中国普通外科杂志, 2003, 12(8): 622-624.
9.	李忠, 左旭辉, 肖越华, 等. 三镜(腹腔镜、胆道镜、十二指肠镜)联合治疗复杂性肝内外胆管结石的研究. 肝胆外科杂志, 2015, 23(1): 46-48.
10.	王坚, 陈炜. 复杂肝外胆管结石的治疗策略. 中华消化外科杂志, 2019, 18(12): 1113-1117.
11.	李绍强, 梁力建, 华赟鹏, 等. 双侧规则性肝段或肝叶切除术治疗复杂性肝内胆管结石. 中山大学学报: 医学科学版, 2009, 30(6): 780-783.
12.	Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center. Surgery, 2018, 163(4): 714-720.
13.	Tian J, Li JW, Chen J, et al. The safety and feasibility of reoperation for the treatment of hepatolithiasis by laparoscopic approach. Surg Endosc, 2013, 27(4): 1315-1320.
14.	Tsui WM, Chan YK, Wong CT, et al. Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis, 2011, 31(1): 33-48.
15.	Dong CC, Fang CH, Wu TC, et al. Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique. Hepatogastroenterology, 2014, 61(134): 1556-1562.
16.	Aloia TA, Zorzi D, Abdalla EK, et al. Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg, 2005, 242(2): 172-177.
17.	李国伟, 蔡剑锋, 袁年勇, 等. 腹腔镜超声辅助精准肝切除治疗肝内外胆管结石. 中华肝胆外科杂志, 2019, 25(9): 685-688.
18.	陈永军, 蔡小勇, 卢榜裕, 等. 多镜联合治疗复发性胆石症的体会. 重庆医学, 2018, 47(2): 244-246.
19.	刘荣, 李成刚. 腹腔镜肝切除的经验与技术. 中国普外基础与临床杂志, 2012, 19(7): 692-696.
20.	梁霄, 蒋桂星. 腹腔镜肝切除的优势与关键技术. 肝胆外科杂志, 2019, 27(4): 241-243.
21.	程光辉, 白剑, 谢开汉, 等. 肝胆外科手术并发胆汁漏的原因及防治. 中国现代普通外科进展, 2012, 15(9): 748, 756.
22.	Wang HQ, Yang J, Yang JY, et al. Bile leakage test in liver resection: a systematic review and meta-analysis. World J Gastroenterol, 2013, 19(45): 8420-8426.
23.	王坚. 肝胆管结石诊治的难点与对策. 中华消化杂志, 2019, 39(10): 657-660.
24.	雷焦, 张如骐, 杨小波, 等. 腹腔镜与开腹肝切除术治疗肝内胆管结石有效性及安全性的 Meta 分析. 腹腔镜外科杂志, 2017, 22(12): 887-894.

1. 中国医师协会外科医师分会微创外科医师专业委员会. 腹腔镜治疗肝胆管结石病的专家共识(2013 版). 中华消化外科杂志, 2013, 12(1): 1-5.
2. Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology, 2011, 54(1): 173-184.
3. 修典荣, 彭颖. 复杂胆道结石的外科治疗进展. 中华普通外科杂志, 2014, 29(7): 489-490.
4. 尹新民, 朱斯维. 腹腔镜肝切除术的进展. 中国普外基础与临床杂志, 2019, 26(2): 129-132.
5. 杜顺达, 金保, 毛一雷. 腹腔镜肝切除术的规范化问题. 中国普外基础与临床杂志, 2019, 26(2): 133-136.
6. Zeng X, Yang P, Wang W. Biliary tract exploration through a common bile duct incision or left hepatic duct stump in laparoscopic left hemihepatectomy for left side hepatolithiasis: which is better?: a single-center retrospective case-control study. Medicine (Baltimore), 2018, 97(46): e13080.
7. Breitenstein S, DeOliveira ML, Raptis DA, et al. Novel and simple preoperative score predicting complications after liver resection in noncirrhotic patients. Ann Surg, 2010, 252(5): 726-734.
8. 李东华, 陈孝平. 肝内胆管结石的外科治疗. 中国普通外科杂志, 2003, 12(8): 622-624.
9. 李忠, 左旭辉, 肖越华, 等. 三镜(腹腔镜、胆道镜、十二指肠镜)联合治疗复杂性肝内外胆管结石的研究. 肝胆外科杂志, 2015, 23(1): 46-48.
10. 王坚, 陈炜. 复杂肝外胆管结石的治疗策略. 中华消化外科杂志, 2019, 18(12): 1113-1117.
11. 李绍强, 梁力建, 华赟鹏, 等. 双侧规则性肝段或肝叶切除术治疗复杂性肝内胆管结石. 中山大学学报: 医学科学版, 2009, 30(6): 780-783.
12. Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: a propensity, long-term follow-up analysis at a single center. Surgery, 2018, 163(4): 714-720.
13. Tian J, Li JW, Chen J, et al. The safety and feasibility of reoperation for the treatment of hepatolithiasis by laparoscopic approach. Surg Endosc, 2013, 27(4): 1315-1320.
14. Tsui WM, Chan YK, Wong CT, et al. Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis, 2011, 31(1): 33-48.
15. Dong CC, Fang CH, Wu TC, et al. Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique. Hepatogastroenterology, 2014, 61(134): 1556-1562.
16. Aloia TA, Zorzi D, Abdalla EK, et al. Two-surgeon technique for hepatic parenchymal transection of the noncirrhotic liver using saline-linked cautery and ultrasonic dissection. Ann Surg, 2005, 242(2): 172-177.
17. 李国伟, 蔡剑锋, 袁年勇, 等. 腹腔镜超声辅助精准肝切除治疗肝内外胆管结石. 中华肝胆外科杂志, 2019, 25(9): 685-688.
18. 陈永军, 蔡小勇, 卢榜裕, 等. 多镜联合治疗复发性胆石症的体会. 重庆医学, 2018, 47(2): 244-246.
19. 刘荣, 李成刚. 腹腔镜肝切除的经验与技术. 中国普外基础与临床杂志, 2012, 19(7): 692-696.
20. 梁霄, 蒋桂星. 腹腔镜肝切除的优势与关键技术. 肝胆外科杂志, 2019, 27(4): 241-243.
21. 程光辉, 白剑, 谢开汉, 等. 肝胆外科手术并发胆汁漏的原因及防治. 中国现代普通外科进展, 2012, 15(9): 748, 756.
22. Wang HQ, Yang J, Yang JY, et al. Bile leakage test in liver resection: a systematic review and meta-analysis. World J Gastroenterol, 2013, 19(45): 8420-8426.
23. 王坚. 肝胆管结石诊治的难点与对策. 中华消化杂志, 2019, 39(10): 657-660.
24. 雷焦, 张如骐, 杨小波, 等. 腹腔镜与开腹肝切除术治疗肝内胆管结石有效性及安全性的 Meta 分析. 腹腔镜外科杂志, 2017, 22(12): 887-894.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of laparoscopic hepatectomy in patients with complex hepatolithiasis

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