A Comparative Study Of Laparoscopic And Open Hepatectomy For Hepatolithiasis And Multivariate Analysis Of Postoperative Complications

Object:Hepatolithiasis is a complex and recurrent disease of the biliary system.How to improve the clinical efficacy and long-term prognosis of the patients has always been a difficult problem for hepatobiliary surgeons.Although with the development and wide application of endoscopic instruments and technology,hepatectomy plays an irreplaceable role in the treatment of hepatolithiasis due to its advantages of removing diseased liver and reducing recurrence.In recent years,the scope of laparoscopic hepatectomy is no longer limited to a single liver lobe or segment with the continuous accumulation of surgeons’ experience in laparoscopic surgery.In this study,the efficacy and safety of laparoscopic hepatectomy for hepatolithiasis were compared with that of open hepatectomy,and analyzed the influencing factors of postoperative complications in patients treated by resection.To provide a theoretical basis for the selection of surgical methods and the reduction of postoperative complications.Methods:From January 2016 to December 2020,a total of 122 patients with hepatolithiasis undergoing hepatectomy from The Second Affiliated Hospital of Anhui Medical University were selected as subjects for retrospective analysis.Among them,55 patients were treated by laparoscopic hepatectomy,67 patients were treated by open hepatectomy.General information and clinical characteristics of patients were collected: Gender,age,Body Mass Index（BMI）,Classification by American Society of Anesthesiologists（ASA）,Alanine aminotransferase（ALT）,Aspartate aminotransferase（AST）,Total bilirubin（TBIL）,Direct bilirubin（DBIL）,Alkaline phosphatase（ALP）,albumin（Alb）,Prothrombin time（PT）,complications（mainly including hypertension,diabetes,coronary atherosclerotic heart disease,bronchiectasis,asthma,pulmonary hypertension,cirrhosis,cerebrovascular disease,nephropathy,systemic immune disease,etc.）,Epigastric surgery history and stone location.The operation time,blood loss,length of hospital stay,intraoperative hilar occlusion rate,stone clearance rate,incidence of postoperative complications（mainly including bleeding,biliary leakage,infection,effusion,etc.）and total cost were compared between the two groups.According to the occurrence of postoperative complications,patients were divided into the complication group（n=22）and the non-complication group（n=100）,and the influencing factors of postoperative complications were analyzed by logistic multifactor regression.Results:Compared with the open group,the operation time of the laparoscopic group was longer,and the removal time of the abdominal drainage tube and the postoperative hospital stay were shorter.There were no significant differences in intraoperative blood loss,Pain degree of postoperative 1 day,first ventilation time,total cost,transfusion rate,hilar occlusion rate,postoperative complication rate and stone residual rate.Multivariate logistic regression analysis showed that intraoperative hilar occlusion was a risk factor for postoperative complications（β=-1.136,OR=0.321,95% CI=0.120～0.861,P=0.024）.Conclusion: There was no significant difference in blood transfusion rate,stone residual rate and postoperative complication rate between laparoscopic hepatectomy and open hepatectomy in treating hepatolithiasis.Compared with open hepatectomy,laparoscopic hepatectomy in the treatment of hepatolithiasis has a shorter length of catheter and hospital stay.Intraoperative hilar occlusion is a risk factor for complications after hepatectomy for hepatolithiasis.