| Objective:The clinical data of laparoscopic hepatectomy was retrospectively analyzed to compare the advantages of two kinds of main surgical process(hepatectomy or extrahepatic choledochotomy as a priority)and secondary surgery process(dissection of the hilum or separation of perihepatic ligam as a priority),and explore the optimal operation process of laparoscopic hepatectomy in the treatment of intrahepatic cholelithiasis.Methods: The clinical data of 87 patients with intrahepatic cholelithiasis treated by laparoscopic surgery in the First Affiliated Hospital of Wannan Medical College from March 2015 to December 2019 were retrospectively analyzed.According to the general procedure of operation,59 patients underwent hepatectomy before exploration of extrahepatic bile duct(group A),and 28 patients underwent hepatectomy after hepatectomy(group B).The operatioan time,intraoperative hemorrhage,intraoperative blood transfusion,postoperative hospital stay,drainage tube removal time,feeding time,analgesic use,time of beginning get out of bed,total hospitalization cost,postoperative complications,liver function alanine aminotransferase(ALT),aspartate aminotransferase(AST)on the 5th day after operation in two groups were compared.According to the secondary procedure of operation,35 cases of hepatectomy were assigned to group C,who underweng dissection of the hilum as a priority,and the other 52 cases underwent perihepatic ligam separation-first were included in Group D.The time of hepatic hilum dissection,total time of hepatectomy of the two groups were compared combined with the operation experience.Results: The operation time [(221.14 ± 48.48min)] of group A was significantly shorter than that of group B [(296.68 ± 79.58min),(P < 0.05)].The intraoperative bleeding volume [(218.10 ± 42.85ml)] of group A was significantly lower than that of group B [(323.79 ± 40.21ml),(P < 0.05)].The intraoperative blood transfusion volume [(195.24 ± 111.70ml)] of group A was slightly lower than that of group B [(237.93 ± 134.73ml),(P > 0.05)].The postoperative hospitalization time of group A [(8.37 ± 1.65d)] was shorter than that of group B [(9.18 ± 2.58d),(P < 0.05)].The removal time of postoperative drainage tube of group A [(8.17 ± 2.79d)] was slightly shorter than that of group B [(8.24 ± 1.78d),(P < 0.05)].The postoperative eating time of group A [(3.10 ± 1.57d)] was slightly shorter than that of group B [(3.96 ± 1.77d),(P > 0.05)].The number of postoperative analgesic(dizosin)in group A [(14.78±7.10)] was significantly less than that in group B [(19.93±9.01),(P < 0.05)].The activity time of getting out of bed in group A [(2.73 ± 1.40d)] was slightly less than that in group B [(3.18 ± 1.59d),(P > 0.05)].The ALT [(62.94 ± 37.45U/L)and AST(23.31 ± 15.85U/L)] of group A were lower than those of group B ALT [(90.62 ± 91.42U/L)and AST(37.25 ± 24.96U/L)] on the 5th day after operation(P < 0.05).The pain score [(2.24 ± 0.77)] on the third day after operation in group A was lower than that in group B [(2.96 ± 1.32),(P <0.05)].The total cost of hospitalization in group A [(51062.15 ± 10526.66)] was slightly smaller than that in group B [(53570.04 ± 8619.94),(P > 0.05)].Postoperative complications in group A included 2 cases(3.4%)of incision infection,41 cases(69.5%)of postoperative fever,2 cases(3.4%)of ascites,1 case(1.7%)of cholangitis,1 case(1.7%)of bile leakage,1 case(1.7%)of biliary hemorrhage,4 cases(6.8%)of stone recurrence;postoperative complications in group B included 1 case of incision infection(3.6%),22 cases of postoperative fever(78.6%),3 cases of peritoneal effusion(10.7%),1 case of cholangitis(3.6%),0 case of bile leakage(0%),biliary bleeding 2 cases(7.1%)and recurrence of stones in 2 cases(7.1%).There was no significant difference in postoperative complications between the two groups(P > 0.05).The time of dissecting hilum in group C [(15.11 ± 2.93min)] was significantly shorter than that in group D(19.44 ± 3.65min),(P < 0.05)].The total time of hepatectomy in group C [(38.00 ± 4.61min)] was shorter than that in group D [(49.94 ± 5.54min),(P < 0.05)].The perihepatic ligament in group C,especially the falciform ligament,played a role in suspending the liver during dissecting hilum compared with that in Group D,and is beneficial to the exposure of hilum.Conclusion: 1.Laparoscopic hepatectomy is safe and effective in the treatment of intrahepatic cholelithiasis.It can not only remove the focus,but also meet the requirements of minimally invasive surgery,and bring better prognosis and less surgical trauma to patients.2.Laparoscopic hepatectomy should be performed first with hepatectomy followed by extrahepatic bile duct incision and stone extraction,which may be the best operation procedure.The advantages of laparoscopic hepatectomy include minimized bile pollution,shorten operation time,reduced intraoperative bleeding,decreased postoperative pain and useage of analgesics,earlier removal of drainage tube,shorten postoperative hospital stay.The main procedure is more in line with the concepts of precision surgery,minimally invasive surgery and rapid recovery.3.The operation procedure of laparoscopic hepatectomy is preferred to dissect the porta hepatis and occlude hepatic inflow before separating perihepatic ligams.The perihepatic ligasms can play a role in partially suspending the liver,which is is better for the exposure and dissection of the porta hepatis,thus shortening the operation time. |
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