Analysis Of The Curative Effect Of Regular Hepatectomy For Hepatolithiasis

Objectives Calculi residual and calculi recurrence is a difficult problem in the surgical treatment of hepatolithiasis.Partial hepatectomy is considered as one of the most effective treatments for hepatolithiasis.Partial hepatectomy is considered as one of the most effective treatment methods for hepatolithiasis,and its intraoperative residual stone rate and postoperative recurrence rate are significantly lower than cholangiotomy and lithotomy,t-tube drainage or choledochojejunostomy.However,patients with cholelithiasis who underwent partial hepatectomy still had a higher proportion of residual stones and recurrent stones.Therefore,the exploration of active and effective treatment of hepatolithiasis has been a hot research topic for biliary surgeons.This study retrospectively analyzed the clinical records of 64 patients with hepatolithiasis who underwent partial hepatectomy,aiming to compare the clinical efficacy of regular hepatectomy and irregular hepatectomy in the treatment of hepatolithiasis.Methods Clinical records of 89 patients with hepatolithosis who underwent partial hepatectomy in the department of hepatobiliary surgery of the former shenyang pia hospital from January 1,2012 to June 30,2018 were retrospectively analyzed.25 cases were excluded and 64 cases were included through inclusion and exclusion criteria.The medical records were divided into two groups according to different treatment plans.The first group was the regular hepatectomy group(19 cases in the regular group),and the second group was the irregular hepatectomy group(45 cases in the irregulargroup).Comparative analysis of regular hepatectomy group and irregular hepatectomy group operating time(h),intraoperative blood loss(ml),ALT(U/L)on the first day after surgery,ALT(U/L)on the third day,within 72 hours after the total flow rate(ml)and postoperative complications(bleeding,infection of incision,abdominal infection orseroperitoneum,bile leakage),postoperative hospitalization days(d),the length of the total cost(RMB ten thousand),the residual rate of calculus(%)(first review postoperative intrahepatic presence of stone residues)and calculi recurrence rate(%)(hospital discharge after six months follow-up intrahepatic presence of calculi recurrence)parameters such as the differences.SPSS20.0 statistical software was used for statistical analysis.Independent student's t-test or rank sum test were used for measurement data,and chi-square test was used for rates.P < 0.05 was considered statistically significant.Results The postoperative hospitalization days of patients in the regular hepatectomy group were significantly shorter than those in the irregular hepatectomy group(10.9VS14.2,P=0.049).The stone residual rate in the regular hepatectomy group was significantly lower than that in the irregular hepatectomy group(0% vs 42.5%,P=0.001).Compared with the irregular hepatectomy group,the recurrence rate of stones in the regular hepatectomy group was also significantly reduced(5.3% vs 38.5%,P=0.010).The operative time,intraoperative blood loss,ALT on the first day after surgery,ALT on the third day after surgery,total drainage volume within 72 hours after surgery,postoperative complications(bleeding,incision infection,abdominal infection orseroperitoneum,bile leakage)and total hospitalization cost between the two groups were not statistically significant(all P > 0.05).Conclusion Regular hepatectomy for hepatolithiasis has lower residual stone rate and stone recurrence rate,and the operative time,intraoperative blood loss and postoperative complications are not different from that of irregular hepatectomy.In addition,the regular hepatectomy group is more consistent with the ERAS concept,with shorter postoperative hospitalization time,and significantly better clinical treatment effect than the irregular hepatectomy group,which is worthy of wideapplication in clinical practice.