Comparative Study Of Laparoscopic And Open Left Hepatectomy For Intrahepatic Bile Duct Stones

Objective:The clinical data of paitents who were underwent laparoscopic left hepatectomy or open left hepatectomy for the treatment of intrahepatic bile duct stones were compared,and the effects of two surgical methods were discussed.Methods:The clinical data of 91 patients with intrahepatic bile duct stones treated in our hospital between April 2015 and April 2019 were retrospectively analyzed.According to different operative methods,These patients were divided into observation group(48 cases)and control group(43 cases).Patients in the observation group were underwent laparoscopic left hepatectomy,and patients in the control group were underwent traditional open left hepatectomy.Compare the following indicators between the two groups,the intraoperative situation:including operation time,Intraoperative blood loss and the approach of bile duct exploration;the postoperative conditions:including postoperative exhaust time,postoperative off-bed time and Postoperative hospital stay;the postoperative complications: including pulmonary infection,bile leakage,incisional infection,abdominal infection;the changes in ALT,AST,TIBL,ALB on the 1st and the 7th day after the operation;the follow-up results:including surgical effect,the rate of residual stones,the rate of recurrent stones,and the incidence of postoperative cholangiocarcinoma.Results:1 Comparison of intraoperative and postoperative conditions between the two groups: the observation group’s operation time was longer than that of the control group,the difference was statistically significant(P<0.05).Theobservation group’s postoperative exhaust time,postoperative off-bed time and Postoperative hospital stay were all shorter than the control group,the difference was statistically significant(P<0.05).There was no significant difference in the Intraoperative blood loss between the two groups of patients(P> 0.05).Compared with the bile duct exploration in the two groups,in the observation group,42 cases underwent bile duct exploration via the common bile duct approach and 6 cases via the left hepatic duct stump approach,and37 patients in the control group underwent the common bile duct approach and5 via the left hepatic duct stump approach bile duct exploration,the difference was not statistically significant(P> 0.05).2 Comparison of postoperative complications between the two groups: In the observation group,10 patients experienced postoperative complications,including 4 cases of pulmonary infection,3 cases of bile leakage,2 cases of incision infection and 1 case of abdominal infection;12 patients in the control group occurred postoperative complications,including 5 cases of pulmonary infection,3 cases of bile leakage,3 cases of incisional infection and 1 case of abdominal infection.There was no significant difference in postoperative complications between the two groups(P>0.05).3 Comparison of hepatic function indexes after the operation between two groups: there was no significant difference in the hepatic function(ALT,AST,ALB,TIBL)between the observation group and the control group on the1 st and 7th day after the operation.(P> 0.05).4 Comparison of follow-up results: 3 cases with residual stone in the observation group(7.1%),and 2 cases with residual stone in the control group(8.1%),There is no statistical difference in the residual stone rate between the two groups(P> 0.05).Two cases(4.8%)had recurrence of stones in the observation group;one(2.7%)had recurrence of stones in the control group.There was no significant difference between the two groups(P> 0.05).The excellent and good surgery rate was 95.2% in the observation group and97.3% in the control group.No patients with cholangiocarcinoma occurred during the follow-up period.There was no significant difference between thetwo groups(P>0.05).Conclusion:Laparoscopic left hepatectomy for the treatment of intrahepatic bile duct stones is effective and reliable.Compared with open left hepatectomy for the treatment of intrahepatic bile duct stones,it has the advantages of less trauma and quicker postoperative recovery,and is worthy of promotion by qualified hospitals application.