| Part 1Research background and purpose:Hepatolithiasis is a common disease of the biliary tract in clinic.Due to its complicated condition,long course of disease,many complications and high recurrence rate,it is difficult to treat the disease in clinic,and the diagnosis and treatment of recurrent hepatolithiasis is even more difficult.Although laparoscopic surgery has been widely carried out and has the advantages of smaller incision,faster recovery and less bleeding compared with open surgery,there are few reports on laparoscopic hepatectomy for recurrent hepatolithiasis,and further studies are still needed to provide sufficient evidence-based medical evidence for its safety and effectiveness.Therefore,this study will compare the safety and effectiveness of laparoscopic and open hepatectomy in the treatment of recurrent hepatolithiasis,and provide a scientific basis for improving the clinical efficacy of patients with recurrent hepatolithiasis,with a view to forming a systematic and standardized treatment plan.Data and methods:Data of patients who underwent laparoscopic hepatectomy and open hepatectomy for recurrent hepatolithiasis in the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Chengdu Medical College from January 2014 to June 2022 were retrospectively collected.A total of 94 patients met the inclusion and exclusion criteria.Clinical data were collected,including general information of patients,surgical methods,surgical procedures,evaluation indicators related to clinical outcomes(stone clearance rate,etc.),stone recurrence rate,intraoperative risk and postoperative complication rate,etc.,to compare the differences in preoperative,intraoperative,postoperative and complication data between the two groups.Results:A total of 94 patients were included in the laparoscopy group and the laparotomy group,including 47 patients in the laparoscopy group and 47 patients in the laparotomy group.All operations were successfully completed without death.1.Preoperative data comparison: comparing the gender composition,age,albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),total bile acid(TBA),combined diabetes mellitus,combined hypertension,combined cirrhosis,previous biliary surgery mode and other preoperative general data between the two groups There were no statistical differences in the preoperative data such as TBIL,direct bilirubin(DBIL),total bile acid(TBA),combined diabetes,combined hypertension,combined cirrhosis,previous biliary surgery,and number of previous biliary surgery(P>0.05).2.Intraoperative results were compared: Compared with the open group,the operation time in the laparoscopic group was slightly longer,but the intraoperative blood loss and intraoperative blood transfusion rate in the laparoscopic group were lower than those in the open group,with statistical significance(P<0.05).3.Comparison of postoperative results: Compared with the open group,the WBC,ALT and AST in the laparoscopic group were lower on the first day after surgery,and the difference was statistically significant(P<0.05).At the same time,the time of getting out of bed after surgery,the time of anal exhaust,the time of liver function recovery,the time of drainage tube retention and the time of hospitalization after surgery in the laparoscopic group were shorter than those in the open group,and the rate of postoperative abdominal incision infection was also lower than that in the open group,with statistical significance(P<0.05).However,the total hospitalization cost in laparoscopic group was higher than that in open group,the difference was statistically significant(P<0.05).There were no significant differences in other postoperative complications(bile leakage,pulmonary infection,stone residue),stone recurrence rate and cancer rate between the two groups(P>0.05).Conclusion:The safety and effectiveness of laparoscopic hepatectomy in the treatment of recurrent hepatolithiasis are comparable to that of open surgery,and laparoscopic hepatectomy has the advantages of less trauma and faster recovery,which is worthy of clinical application.Part 2Research background and purpose:The high recurrence rate of hepatolithiasis after surgery is still a difficult problem for clinicians,so the prevention of recurrence after surgery is very important.Finding effective drugs to prevent the recurrence of hepatolithiasis is a hot issue in current research.Therefore,this study will explore the preventive effect of Xiaoyan Lidan Tablets combined with ursodeoxycholic acid tablets on the recurrence of hepatolithiasis after hepatectomy.Data and methods:A total of 86 patients who underwent hepatectomy for hepatolithiasis in the Department of Hepatobiliary and Pancreatic Surgery of the First Affiliated Hospital of Chengdu Medical College from January 2018 to June 2022 were retrospectively analyzed.A total of 86 cases met the inclusion and exclusion criteria,and were divided into drug-taking group and control group after surgery,in which there were 51 cases in the drug-taking group and 35 cases in the control group,and the drug-taking group received oral anti-inflammatory and cholestatic tablets combined with ursodeoxycholic acid tablets,and the control group did not receive the above The control group did not take the above two drugs orally.Relevant clinical data,including preoperative general information,surgical methods,and surgical procedures,were collected,followed up the two groups of patients,observed the recurrence of stones in the two groups,and compared the difference in postoperative stone recurrence rates between the two groups.Results:A total of 86 patients were included in the drug-taking group and the control group,and there was no statistically significant difference between the two groups in terms of general information such as preoperative age,gender,and surgical method(P>0.05);there were 51 cases in the drug-taking group and 35 cases in the control group,and the patients were followed up for 6 to 58 months,with a median follow-up of 34 months.The recurrence rate of stones in the drug-taking group was 9.8%,compared with 31.4% in the control group.The recurrence rate of stone in the medication group was lower than that in the control group(P<0.05).Conclusion:After hepatectomy for hepatolithiasis,the recurrence rate of hepatolithiasis after taking orally Xiaoyanlidan Tablets combined with ursodeoxycholic acid tablets is lower than that without taking orally the above two groups of drugs,indicating that oral Xiaoyanlidan Tablets combined with ursodeoxycholic acid tablets can prevent the recurrence of hepatolithiasis after hepatectomy. |
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