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.	中國醫師協會外科醫師分會微創外科醫師專業委員會. 腹腔鏡治療肝膽管結石病的專家共識(2013 版). 中華消化外科雜志, 2013, 12(1): 1-5.
2.	Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology, 2011, 54(1): 173-184.
3.	修典榮, 彭穎. 復雜膽道結石的外科治療進展. 中華普通外科雜志, 2014, 29(7): 489-490.
4.	尹新民, 朱斯維. 腹腔鏡肝切除術的進展. 中國普外基礎與臨床雜志, 2019, 26(2): 129-132.
5.	杜順達, 金保, 毛一雷. 腹腔鏡肝切除術的規范化問題. 中國普外基礎與臨床雜志, 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.	李東華, 陳孝平. 肝內膽管結石的外科治療. 中國普通外科雜志, 2003, 12(8): 622-624.
9.	李忠, 左旭輝, 肖越華, 等. 三鏡(腹腔鏡、膽道鏡、十二指腸鏡)聯合治療復雜性肝內外膽管結石的研究. 肝膽外科雜志, 2015, 23(1): 46-48.
10.	王堅, 陳煒. 復雜肝外膽管結石的治療策略. 中華消化外科雜志, 2019, 18(12): 1113-1117.
11.	李紹強, 梁力建, 華赟鵬, 等. 雙側規則性肝段或肝葉切除術治療復雜性肝內膽管結石. 中山大學學報: 醫學科學版, 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.	李國偉, 蔡劍鋒, 袁年勇, 等. 腹腔鏡超聲輔助精準肝切除治療肝內外膽管結石. 中華肝膽外科雜志, 2019, 25(9): 685-688.
18.	陳永軍, 蔡小勇, 盧榜裕, 等. 多鏡聯合治療復發性膽石癥的體會. 重慶醫學, 2018, 47(2): 244-246.
19.	劉榮, 李成剛. 腹腔鏡肝切除的經驗與技術. 中國普外基礎與臨床雜志, 2012, 19(7): 692-696.
20.	梁霄, 蔣桂星. 腹腔鏡肝切除的優勢與關鍵技術. 肝膽外科雜志, 2019, 27(4): 241-243.
21.	程光輝, 白劍, 謝開漢, 等. 肝膽外科手術并發膽汁漏的原因及防治. 中國現代普通外科進展, 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.	王堅. 肝膽管結石診治的難點與對策. 中華消化雜志, 2019, 39(10): 657-660.
24.	雷焦, 張如騏, 楊小波, 等. 腹腔鏡與開腹肝切除術治療肝內膽管結石有效性及安全性的 Meta 分析. 腹腔鏡外科雜志, 2017, 22(12): 887-894.

1. 中國醫師協會外科醫師分會微創外科醫師專業委員會. 腹腔鏡治療肝膽管結石病的專家共識(2013 版). 中華消化外科雜志, 2013, 12(1): 1-5.
2. Tyson GL, El-Serag HB. Risk factors for cholangiocarcinoma. Hepatology, 2011, 54(1): 173-184.
3. 修典榮, 彭穎. 復雜膽道結石的外科治療進展. 中華普通外科雜志, 2014, 29(7): 489-490.
4. 尹新民, 朱斯維. 腹腔鏡肝切除術的進展. 中國普外基礎與臨床雜志, 2019, 26(2): 129-132.
5. 杜順達, 金保, 毛一雷. 腹腔鏡肝切除術的規范化問題. 中國普外基礎與臨床雜志, 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. 李東華, 陳孝平. 肝內膽管結石的外科治療. 中國普通外科雜志, 2003, 12(8): 622-624.
9. 李忠, 左旭輝, 肖越華, 等. 三鏡(腹腔鏡、膽道鏡、十二指腸鏡)聯合治療復雜性肝內外膽管結石的研究. 肝膽外科雜志, 2015, 23(1): 46-48.
10. 王堅, 陳煒. 復雜肝外膽管結石的治療策略. 中華消化外科雜志, 2019, 18(12): 1113-1117.
11. 李紹強, 梁力建, 華赟鵬, 等. 雙側規則性肝段或肝葉切除術治療復雜性肝內膽管結石. 中山大學學報: 醫學科學版, 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. 李國偉, 蔡劍鋒, 袁年勇, 等. 腹腔鏡超聲輔助精準肝切除治療肝內外膽管結石. 中華肝膽外科雜志, 2019, 25(9): 685-688.
18. 陳永軍, 蔡小勇, 盧榜裕, 等. 多鏡聯合治療復發性膽石癥的體會. 重慶醫學, 2018, 47(2): 244-246.
19. 劉榮, 李成剛. 腹腔鏡肝切除的經驗與技術. 中國普外基礎與臨床雜志, 2012, 19(7): 692-696.
20. 梁霄, 蔣桂星. 腹腔鏡肝切除的優勢與關鍵技術. 肝膽外科雜志, 2019, 27(4): 241-243.
21. 程光輝, 白劍, 謝開漢, 等. 肝膽外科手術并發膽汁漏的原因及防治. 中國現代普通外科進展, 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. 王堅. 肝膽管結石診治的難點與對策. 中華消化雜志, 2019, 39(10): 657-660.
24. 雷焦, 張如騏, 楊小波, 等. 腹腔鏡與開腹肝切除術治療肝內膽管結石有效性及安全性的 Meta 分析. 腹腔鏡外科雜志, 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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