Clinical Application of Precise Hepatectomy Techniques in Hepatolithus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 WEI Yangnian , HUANG Hai , MO Shifa , WANG Kejing , ZHANG Hongchang , TAN Xinhua , LI Quan.

Department of Hepatobiliary Surgery, The Second Affiliated Hospital (Ruikang Hospital) of Guangxi Traditional Chinese Medical University, Nanning 530011, Guangxi, China;

Corresponding author：

WEI Yangnian, Email: wyn200420154@yahoo.com.cn

Keywords：

Hepatolithus; Minimally invasive surgery; Precise hepatectomy; Irregular hepatectomy; Dissection hepatectomy; Transection hepatectomy

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ObjectiveTo explore the curative effect of precise hepatectomy techniques in hepatolithus. MethodsTotally 132 patients underwent precise hepatectomy and 52 patients underwent irregular hepatectomy were retrospectively analyzed, and the intraoperative and postoperative indexes such as operation time, blood loss, postoperative complications, hospitalization time, clearance rate of calculus, and cost of hospitalization were analyzed. ResultsCompared with the patients in irregular hepatectomy group, although the operative time was longer in precise hepatectomy group 〔(364.6±57.8) min vs. (292.9±44.7) min, P lt;0.001〕, but the patients in precise hepatectomy group had less blood loss 〔(558.3±90.6) ml vs. (726.7±88.7) ml, P lt;0.001〕, less postoperative complications (11.4% vs. 23.1%，P=0.004 3), and higher clearance rate of calculus (89.4% vs. 73.1%, P=0.005 5). Thus, the patients in precise hepatectomy group had shorter hospital stay 〔(22.9±4.4) d vs. (28.8±3.5) d, P lt;0.001〕 and less cost of hospitalization 〔(1.8±0.7)×104 yuan vs. (2.1±0.9)×104 yuan, P=0.016 5〕. Conclusion　Precise hepatectomy is better than irregular hepatectomy in treatment for hepatolithus.

Citation： WEI Yangnian,HUANG Hai,MO Shifa,WANG Kejing,ZHANG Hongchang,TAN Xinhua,LI Quan.. Clinical Application of Precise Hepatectomy Techniques in Hepatolithus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(1): 67-72. doi: Copy

1.	董家鸿, 黄志强. 精准肝切除-21世纪肝脏外科新理念 [J]. 中华外科学杂志, 2009, 47(21): 16011605.
2.	黄志强. 肝内胆管结石手术方法的选择 [J]. 中国实用外科杂志, 1994, 14(3): 136138.
3.	梁力建, 李绍强, 彭宝岗, 等. 肝切除术治疗肝内胆管结石 [J]. 中华肝胆外科杂志, 2006, 12(12): 796800.
4.	Chen DW, TungPing Poon R, Liu CL, et al. Immediate and longterm outcomes of hepatectomy for hepatolithiasis [J]. Surgery, 2004, 135(4): 386393.
5.	韩殿冰, 董家鸿. 肝切除治疗肝胆管结石病治疗效果的Meta分析 [J]. 消化外科, 2006, 5(3): 194196.
6.	黄志强. 肝内胆管结石外科治疗的进展 [J]. 中国实用外科杂志, 2004, 24(2): 6566.
7.	杨连粤, 杨平洲. 肝内结石的肝切除术 [J]. 世界华人消化杂志, 2001, 9(6): 664665.
8.	Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [J]. Arch Surg, 2002, 137(2): 149153.
9.	韩殿冰, 董家鸿, 郭光金. 对1 259例肝胆管结石病临床病理分型评价 [J]. 第三军医大学学报, 2006, 28(12): 13371338.
10.	董家鸿. 肝胆管结石的临床病理类型与手术方式的选择 [J]. 外科理论与实践, 2003, 8(2): 99100.
11.	黄洁夫主译. Blumgart LH, Belghiti J, Jarnagin WR, et al. Surgery of the liver, biliary tract, and pancreas [M]. 4th ed. 北京：人民卫生出版社, 2010: 6768.
12.	王学浩, 陆森. 肝切除技术的现状 [J]. 中国普外基础与临床杂志, 2010, 17(6): 525527.
13.	王宏光, 张煊, 董家鸿. 腹腔镜肝切除技术的优化 [J]. 中国普外基础与临床杂志, 2010, 17(6): 538542.
14.	董家鸿, 何蕾, 张文智, 等. 精准肝脏外科技术在复杂肝脏占位性病变切除中的应用 [J]. 中华外科杂志, 2009, 47(21): 16101615.
15.	Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559.
16.	Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B [J]. Hepatology, 2007, 45(1): 97101.
17.	Welsh FK, Ramsden CW, MacLennan K, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice [J]. Ann Surg, 1998, 227(2): 205212.
18.	Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304.
19.	Lang H, Radtke A, Hindennach M, et al. Impact of virtual tumor resection and computerassisted risk analysis on operation planning and intraoperative strategy in major hepatic resection [J]. Arch Surg, 2005, 140(7): 629638.
20.	文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008, 15(4): 299302.
21.	王鲁, 孙惠川, 钦伦秀, 等. 肝癌解剖性肝切除的初步经验 [J]. 中国普外基础与临床杂志, 2007, 14(1): 3941.
22.	Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a nonanatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey [J]. Surgery, 2008, 143(4): 469475.
23.	Descottes B, Lachachi F, Durand Fontanier S, et al. Right hepatectomies without vascular clamping: report of 87 cases [J]. J Hepatobiliary Pancreat Surg, 2003, 10(1): 9094.
24.	Yamamoto Y, Ikai I, Kume M, et al. New simple techique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping [J]. World J Surg, 1999, 23(10): 10321037.
25.	许斌, 王建伟, 洪德飞, 等. 规则性肝切除治疗肝内胆管结石的临床分析 [J]. 中华医学杂志, 2006, 86(24): 17211723.
26.	黄志强, 黄晓强, 宋青. 黄志强胆道外科手术学 [M]. 第2版. 北京: 人民军医出版社, 2010: 142147.

1. 董家鸿, 黄志强. 精准肝切除-21世纪肝脏外科新理念 [J]. 中华外科学杂志, 2009, 47(21): 16011605.
2. 黄志强. 肝内胆管结石手术方法的选择 [J]. 中国实用外科杂志, 1994, 14(3): 136138.
3. 梁力建, 李绍强, 彭宝岗, 等. 肝切除术治疗肝内胆管结石 [J]. 中华肝胆外科杂志, 2006, 12(12): 796800.
4. Chen DW, TungPing Poon R, Liu CL, et al. Immediate and longterm outcomes of hepatectomy for hepatolithiasis [J]. Surgery, 2004, 135(4): 386393.
5. 韩殿冰, 董家鸿. 肝切除治疗肝胆管结石病治疗效果的Meta分析 [J]. 消化外科, 2006, 5(3): 194196.
6. 黄志强. 肝内胆管结石外科治疗的进展 [J]. 中国实用外科杂志, 2004, 24(2): 6566.
7. 杨连粤, 杨平洲. 肝内结石的肝切除术 [J]. 世界华人消化杂志, 2001, 9(6): 664665.
8. Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [J]. Arch Surg, 2002, 137(2): 149153.
9. 韩殿冰, 董家鸿, 郭光金. 对1 259例肝胆管结石病临床病理分型评价 [J]. 第三军医大学学报, 2006, 28(12): 13371338.
10. 董家鸿. 肝胆管结石的临床病理类型与手术方式的选择 [J]. 外科理论与实践, 2003, 8(2): 99100.
11. 黄洁夫主译. Blumgart LH, Belghiti J, Jarnagin WR, et al. Surgery of the liver, biliary tract, and pancreas [M]. 4th ed. 北京：人民卫生出版社, 2010: 6768.
12. 王学浩, 陆森. 肝切除技术的现状 [J]. 中国普外基础与临床杂志, 2010, 17(6): 525527.
13. 王宏光, 张煊, 董家鸿. 腹腔镜肝切除技术的优化 [J]. 中国普外基础与临床杂志, 2010, 17(6): 538542.
14. 董家鸿, 何蕾, 张文智, 等. 精准肝脏外科技术在复杂肝脏占位性病变切除中的应用 [J]. 中华外科杂志, 2009, 47(21): 16101615.
15. Clavien PA, Petrowsky H, DeOliveira ML, et al. Strategies for safer liver surgery and partial liver transplantation [J]. N Engl J Med, 2007, 356(15): 15451559.
16. Kumar M, Satapathy S, Monga R, et al. A randomized controlled trial of lamivudine to treat acute hepatitis B [J]. Hepatology, 2007, 45(1): 97101.
17. Welsh FK, Ramsden CW, MacLennan K, et al. Increased intestinal permeability and altered mucosal immunity in cholestatic jaundice [J]. Ann Surg, 1998, 227(2): 205212.
18. Saito S, Yamanaka J, Miura K, et al. A novel 3D hepatectomy simulation based on liver circulation: application to liver resection and transplantation [J]. Hepatology, 2005, 41(6): 12971304.
19. Lang H, Radtke A, Hindennach M, et al. Impact of virtual tumor resection and computerassisted risk analysis on operation planning and intraoperative strategy in major hepatic resection [J]. Arch Surg, 2005, 140(7): 629638.
20. 文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008, 15(4): 299302.
21. 王鲁, 孙惠川, 钦伦秀, 等. 肝癌解剖性肝切除的初步经验 [J]. 中国普外基础与临床杂志, 2007, 14(1): 3941.
22. Eguchi S, Kanematsu T, Arii S, et al. Comparison of the outcomes between an anatomical subsegmentectomy and a nonanatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey [J]. Surgery, 2008, 143(4): 469475.
23. Descottes B, Lachachi F, Durand Fontanier S, et al. Right hepatectomies without vascular clamping: report of 87 cases [J]. J Hepatobiliary Pancreat Surg, 2003, 10(1): 9094.
24. Yamamoto Y, Ikai I, Kume M, et al. New simple techique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator and bipolar cautery equipped with a channel for water dripping [J]. World J Surg, 1999, 23(10): 10321037.
25. 许斌, 王建伟, 洪德飞, 等. 规则性肝切除治疗肝内胆管结石的临床分析 [J]. 中华医学杂志, 2006, 86(24): 17211723.
26. 黄志强, 黄晓强, 宋青. 黄志强胆道外科手术学 [M]. 第2版. 北京: 人民军医出版社, 2010: 142147.

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