Comparison Of Laparoscopic And Open Hepatectomy Liver Section Effect On Treatment Of Intrahepatic Duct Stones

Research Background:Intrahepatic Duct(IHD)Stones is a complicated common clinical disease,so far open anatomical hepatectomy is still considered as the standard surgical approach for IHD stones.The application of laparoscope is more and more widespread in recent years,however,it is limited by technical difficulties caused by adhesion to adjacent tissue or distorted anatomy resulting from recurrent inflammation.Research Purpose:Evaluate and compare the perioperative and clinical outcomes of Laparoscopic and Open Hepatectomy Liver Section for Intrahepatic Duct Stones,analyze the safety、effectiveness and advantages of laparoscopic hepatectomy.Methods:Make a retrospective analysis of the data of patients who have received surgical resection during January 2012 to January 2017 in Qilu Hospital of Shandong University.22 patients underwent laparoscopic hepatectomy,including left hemihepatectomy(n=7)、left lateral sectionectomy(n=14)and right hemihepatectomy(n=1).30 patients underwent open hepatectomy,including left hemihepatectomy(n=13)、left lateral sectionectomy(n= 17)、right hemihepatectomy(n=1)and right partihepatectomy(n=3).According to the medical records and follow-up data,we compared their perioperative and clinical outcomes,including age、sex、BMI、location of stones、preoperative albumin、postoperative albumin、operation time、estimated blood loss、postoperative liver function、postoperative bilirubin、postoperative drainage tube stay、postoperative hospital stay、fasting time、hospital expenditures、postoperative complications、stone clearance rates、stone recurrent rates etc.All the analyses were performed using SPSS software,version 23.0,Categorical parameters of each group were compared by the x2 text,and denoted by rate.Continuous parameters were compared using the independent-sample t text,and denoted by x±s.All the P values are stand for the bilateral probability.Significance level α=0.05,p value<0.05 was considered statistically significant.Results:There are 52 patients who meet our selection criteria.Of these patients,22 underwent laparoscopic approaches and 30 underwent open approaches.There was no difference in age(58.64±9.209vs53.60±9.099 years,p=0.055)、sex(9:13vs9:21 male:female,p=0.414)、BMI(13:9vs18:12,<24:≥24kg\m2,p=0.947)、liver function(20:2vs27:3,child A:B,p=0.913)、preoperative albumin(42.145±2.900vs39.917±5.993 g\L,p=0.083)between the laparoscopic and open hepatectomy groups;the laparoscopic group had fewer estimated blood loss(117.27±67.414 vs 269.33±369.771 ml,p=0.035)、lower postoperative complication rate(9.1%vs 36.7%,p=0.028)and postoperative transaminase level(Alanine transaminase ALT 93.95±48.958 vs 201.13±166.683 IU\L,p=0.002;Aspartate Aminotransferase AST 89.50±57.138 vs 219.70±236.520 IU\L,p=0.007)、shorter postoperative drainage tube stay(8.59±3.699 vs 16.57±10.523 day,p=0.000)、postoperative hospital stay(11.23±3.308 vs 19.80±11.158 day,p=0.024)、fasting time(2.77±0.922 vs 3.80±1.972 day,p=0.016)、postoperative antibiotics application time(5.86±2.315 vs 7.93±4.025 day,p=0.024)and higher postoperative bilirubin level(36.695±4.546 vs 30.703±4.831 g\L,p=0.000),There was no significant differences in operation time(236.36±104.769 vs 264.17±113.624 min,p=0.372)、intraoperative transfusion(4.5%vs 20.0%,p=0.107)、postoperative total bilirubin level(20.873±20.697 vs 27.110±18.309 umol\L,p=0.256)/postoperative average volume of drainage(76.14±74.573 vs 89.87±60.835 ml,p=0.468)/postoperative transfusion(9.1%vs 13.3%,p=0.636)、stone clearance rates(initial stone clearance rates 86.4%vs 73.3%,p=0.256;final stone clearance rates 100%vs 96.7%,p=0.387)、stone recurrent rates(0%vs 6.7%,p=0.502)、hospital expenditures(48640.45±18879.721 vs 41274.87±14152.497 RMB,p=0.114).Conclusion:laparoscopic hepatectomy is safe and effective for patients with Intrahepatic Duct(IHD)Stones,and has equal curative effect with open approaches.What’s more,laparoscopic hepatectomy resulted in fewer estimated blood loss、lower postoperative complication rate、shorter fasting time、smaller influences on liver function、shorter postoperative hospital stay and smaller incision,worthy of clinical application.