Evaluation Of Different Surgical Treatments For Hepatolithiasis

Objective:By comparison of pure T-tube drainage method, pure choledochojejunostomy, partial hepatectomy&T tube drainage method, partial hepatectomy&choledochojejunostomy method, explore the best surgery medthod which can prevent the biliary stones recurent and Cholangiocarcinoma.Methods:Get out416cases of hepatolithiasis treated in Shandong Povince Hospital from2002to2006, the methods of operation are as follows, pure T-tube drainage method, pure hepaticojejunostomy method, partial hepatectomy&T tube drainage method, partial hepatectomy&hepaticojejunostomy method, pure T-tube drainage method and partial hepatectomy&T tube drainage method bind to T-tube drainage group and pure hepaticojejunostomy method and partial hepatectomy&hepaticojejunostomy method bind to hepaticojejunostomy group. Then a retrospective study about the rates of postoperative complication, postoperative residual stones, stone recurrence, cholangiocarcinoma were analyzed by statistical ways, try to find out the differences of the therapeutic effect of the four surgery methods. The follow-up time is4to10years.Results:Abdominal infection accupied the highest postoperative complication rate whose amount is11(2.64%), and then incision infection is7(1.68%), bile leak is6(1.44%), inflammation of the bile duct is5(1.20%). The complication situation of the four methods of surgery is that, pure T-tube drainage method has2(3.33%), pure hepaticojejunostomy has3(5.77%), partial hepatectomy&T tube drainage method has18(10.98%), partial hepatectomy&hepaticojejunostomy method has15(10.71%). Pure T-tube drainage group(20/224,8.93%) has no obviously difference with hepaticojejunostomy group(18/192,9.40%)(P=0.875, P>0.05). Hepatectomy group (33/304,10.86%) is greatly higher than non-hepatectomy group (5/112,4.46%)(P=0.01, P<0.05). The situation of postoperative residual stone is as follows, pure T-tube drainage group (39/224,17.41%) has no obviously difference with pure hepaticojejunostomy group (33/192,17.18%)(P=0.952, P>0.05). Hepatectomy group (35/304,11.51%) is greatly lower than non-hepatectomy group (37/112,33.04%)(P<0.001). The situation of long-term effect is as follows, the stone recurrence and malignant transformation amount of pure T-tube drainage method is14(24.56%) and3(5.26%), pure hepaticojejunostomy is9(18%) and2(4%), partial hepatectomy&T tube drainage method is18(11.84%) and3(1.97%), partial hepatectomy&hepaticojejunostomy method is6(4.55%) and1(0.75%). Hepatectomy&hepaticojejunostomy method has significantly better long-term effect than partial hepatectomy&T tube drainage method about stone recurrence (P=0.027, P<0.05). The malignant transformation amount of partial hepatectomy&hepaticojejunostomy method is1(1.52%) which has great effect on cancer preventment.Conclusion:By this research, wo conclude that hepatectomy is very important in the treatment of hepatolithiasis which can obviously low the rate of postoperative residual concretions, stone recurrent,postoperative cholangitis, and could prevent from cholangiocarcinoma effectively, because hepatectomy can clear the stone and pathological changed location absolutely, and correct the duct stricture. The hepatectomy also has its own disadvantages which are that the hepatectomy do worse trauma to the body, trigger more complications, especially there are more damage to the body when right or bilateral hepatectomy is excuted and even the liver failure could happen because of the sugery. But if add hepaticojejunostomy in the fundation of hepatectomy which means hepatectomy&hepaticojejunostomy method, a great long-term effect about stone recurrent and cholangiocarcinoma comes. There are two main reasons, one is that this method could shorten the distance of bile entering into the jejunum, then reduce the possibility of cholestasis, the other is that this channel does not go through oddi sphincter, so the oddi sphincter lose the control of bile emptying, and risk factors which oddi sphincter cause to induce cholestasis, stone formation and canceration. Thus we conclude hepatectomy&hepaticojejunostomy method is a good way to cure hepatolithiasis.