Comparison Of Different Surgical Treatments For Hepatolithiasis

Objective:By comparing the short-term and long-term effects and the occurrence of related complications of three different surgical methods of Common bile duct exploration pluse T tube drainage,Hepatectomy and Cholangiojejunostomy for the treatment of hepatolithiasis,so as to evaluate the efficacy of the different surgical methods,and try to provide the best surgical solution for the current surgical treatment of hepatolithiasis.Methods:Patients with hepatolithiasis from the Second Hospital of Jilin University and China-Japan Union Hospital from January 2012 to December 2017 were followed up for clinical data.According to the different surgical procedures,the patients were divided into Common bile duct exploration pluse T tube drainage group(group A),hepatectomy group(group B)and cholangioenterostomy group(group C).The main research contents include the recent complications of patients and long-term complications.Finally,SPSS 25.0 software was used to statistically analyze the data,which was statistically significant at P<0.05.Results:In terms of recent complications,the group B had the highest postoperative complication rate(19.6%),and the group C had a postoperative complication rate of 11.5%.The incidence of postoperative complications is 11.4% in the group A.There is statistical significance between group B and A and C(P<0.05).After choledochoscopy treatment,the residual stone rate in group A,B and C is respectively 8.6%,4.9%and 7.7%.There is no statistically significant difference between the three groups(P<0.05).In terms of stone recurrence,the recurrence rate of bile duct stones in group B(5.1%)is significantly lower than that in group A(25.0%)and group C(26.1%).There is significant difference between group B and A and C(P<0.05).The incidence of postoperative long-term cholangitis is respectively 21.0%,2.5%and 30.4% in group A,B and C.There is statistical significance between group B and group A and group C(P<0.05).In terms of surgical outcome,the excellent and good rate of group B(94.9%)are better than that of group A(81.3%)and group C(73.4%),and the difference between group B and group C is statistically significant(P<0.05);There is only one patient with cancer in group A,which was not statistically significant.Conclusions:1.Continuous development of techniques such as choledochoscopy makes the hepatectomy less and less advantageous in terms of residual stone rate compared with other surgical methods,but hepatectomy is still the best choice in controlling the recurrence of stones and the incidence of cholangitis.2.The high incidence of cholangitis after biliary anastomosis is still an important reason to limit the application of this procedure,the application of cholangioenterostomy should strictly grasp its indications.3.Choledochoscopy combined with Common bile duct exploration pluse T tube drainage for the treatment of hepatolithiasis,making the application range and value of the procedure have been significantly improved.4.The development trend of hepatolithiasis treatment is combined therapy and individualized treatment.