Study on the effect of partial hepatectomy combined with choledochoscopy in the treatment of intrahepatic bile duct stones under laparoscopic left liver pedicle
Song Shuangqing, Ding Zhaowu, Zou Huimin
Department of Hepatobiliary Surgery, the Third People's Hospital of Zhengzhou, Zhengzhou 450000, China
Abstract：Objective To explore the clinical effect of laparoscopic left hepatic pedicle block partial hepatectomy combined with choledochofiberscope in the treatment of intrahepatic bile duct stones.Methods A retrospective analysis of 148 patients with intrahepatic bile duct stones treated surgically from January 2016 to December 2016 was performed, there were 82 males and 66 females, range from 43 to 78 years, mea age was 65.3±10.7. Among them, 69 patients were treated with laparoscopic left hepatic pedicle occlusion, partial hepatectomy combined with fiber choledochoscope lithotripsy (minimally invasive group), and 79 patients with traditional open surgery (laparotomy group). The blood loss, operation time, lithotripsy time, postoperative drainage and hospital stay were compared between two groups. Serum albumin (ALB), alanine aminotransferase (ALT), aspartate amino (AST), total bilirubin (TBIL), serum globulin (G), white blood cells (WBC), neutrophils, cortisol changes in patients with postoperative complications compared the incidence.Results In the minimally invasive group, the amount of operative bleeding, postoperative drainage, and hospital stay were all lower than those in the laparotomy group, while the stone retrieval time was longer than that in the laparotomy group. The difference was statistically significant (all P values<0.01). There were no significant differences in the measured values of ALB, ALT, AST, TBIL, G, WBC, neutrophil and cortisol between the two groups before surgery (all P values>0.05). The levels of serum ALT, AST, TBIL, WBC, neutrophil and cortisol in patients in minimally invasive group were significantly lower than those in laparotomy group on the 1st, 3rd, 7th day after operation (all P values<0.05). However, there was no significant difference between ALB and G proteins (all P values>0.05). Serum levels of ALT, AST, TBIL, WBC and neutrophil in the two groups increased significantly on the first postoperative day and gradually decreased (all P values<0.01). Serum ALB in both groups decreased gradually after operation and recovered on the 7th day after operation (all P values<0.05). Cortisol in both groups gradually increased in the first 3 days after operation and then gradually decreased (all P values<0.05). The incidence of complications in the minimally invasive group was 7.25%(5/69), the laparotomy group was 18.99%(15/79), the difference was statistically significant (χ2=4.344, P<0.05).Conclusions Laparoscopic partial hepatic pedicle blockade combined with partial cholecystectomy and cholecystolithotomy for the treatment of intrahepatic bile duct stones has the advantages of small trauma, rapid postoperative recovery and less complications.
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Song Shuangqing, Ding Zhaowu, Zou Huimin. Study on the effect of partial hepatectomy combined with choledochoscopy in the treatment of intrahepatic bile duct stones under laparoscopic left liver pedicle. Chinese Journal of Anatomy and Clinics, 2018, 23(1): 59-63.
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2018, Vol. 23 
