Regularity Liver Resection Treatment Of Hepatolithiasis

Objective:to analyze the treatment group underwent anatomical liver resection in treatment of hepatolithiasis treatment, study of anatomical liver resection for intrahepatic bile duct stones of the efficacy and safety of.Methods:from 2010 January to 2015 of January in hepatobiliary surgery the Second Affiliated Hospital of Kunming Medical University of Yunnan Province in the treatment group received anatomical liver resection in treatment of hepatolithiasis patients, a total of 126 cases. By preoperative CT, MRI, B ultrasound, MRCP, PTCD and ERCP in diagnosis of intrahepatic bile duct stones. According to the distribution of stones, bile duct stenosis degree and location, and combined with the literature of intrahepatic bile duct stones are divided into five types:type Ⅰ, type Ⅱ for localized area, Ⅲ type, Ⅳ type diffuse sclerosis type and Ⅴ type compound. According to the classification of hepatic segments by anatomic resection, combined hepatectomy, liver and combined liver lobe, combined with intrahepatic and extrahepatic bile duct choledochotomy, choledochojejunostomy. The Ⅰ type and Ⅱ type with regular anatomical liver resection, Ⅲ type diffuse with extrahepatic bile duct incision exploration of hilar bile duct stricture after biliary enteric anastomosis surgery after stone, Ⅳ type hardening by drainage or choledochotomy bile duct stenosis, type Ⅴ according to whether the anatomical liver resection combined with bile duct exploration or bile intestinal anastomosis, in order to achieve the eradication of stones, removal of biliary stricture and liver damage, to drainage, preventing cancer and stone recurrence objective. The postoperative final stone clearance rate, stenosis of bile duct stone clearance rate, postoperative recurrence rate; analysis of the relationship between the distribution of bile duct stricture and operation resection rate, postoperative bile duct stenosis and postoperative residual stones, recurrence relations.Results:1, according to the patients with hepatolithiasis type and individual situation formulate operation scheme, all localized with combined liver resection; the rest were different with liver resection, combined with segmental liver resection and biliary tract exploration, biliary enteric anastomosis and biliary reconstruction.2, the implementation of anatomic hepatectomy for hepatolithiasis patients, preoperative unilateral intrahepatic bile duct stenosis resection rate was significantly higher than that of patients with bilateral stenosis postoperative stenosis resection rate, the difference was statistically significant (P< 0.01). No intrahepatic bile duct residual stenosis patients to stenosis in patients with postoperative residual stones in lower residual and recurrence rate after surgery, there were statistically significant differences (P< 0.001).3, postoperative residual stenosis is an independent risk factor for recurrence of stones after operation:P< 0.05, risk (OR)= 2.8,95% confidence interval (CI):1.127～ 6.956.4, anatomical liver resection for intrahepatic bile duct stones is relatively safe, and peri operation period complication rate is relatively low.Conclusion:1, anatomical liver resection is the treatment of intrahepatic bile duct stones thoroughly, with anatomical liver resection for comprehensive treatment at the base of a variety of lithotomy combination is the development direction in the treatment of hepatolithiasis.2, No residual intrahepatic bile duct stenosis patients to residual stenosis in patients with postoperative residual stones in less than 2, and the rate of recurrence after operation.3, postoperative residual bile duct stenosis is a risk factor for recurrence of cholecystolithiasis.