Treatment Of Right Intrahepatic Cholelithiasis By Hepatectomy

Background:Intrahepatic and extrahepatic cholelithiasis is a common and frequently encountered disease of the biliary system,the treatment method,difficulty and effect are obviously different because of the location of the stone,and the pathological changes of the secondary liver and duct caused by the stone.Considering the following two reasons,we focus on the right intrahepatic bile duct stones:1.In terms of the location,pathological changes and surgical methods of right intrahepatic cholelithiasis,the complexity and difficulty of treatment are significantly higher than those of the left lobe of the liver,which is more different from choledocholithiasis or cholecystolithiasis;2.Because the structure of the right lobe bile duct is more complex and varied,compared with the stones in other parts,there are higher residual stone rate,recurrence rate and complications after operation.Therefore,we take it as a separate location of stone occurrence,to carry on the key analysis research.Objective:To explore the main indications and therapeutic effects of partial hepatectomy in the treatment of right intrahepatic cholelithiasis.Methods:From January 2012 to January 2018,116 cases of right intrahepatic cholelithiasis treated in our hospital were analyzed retrospectively,the above patients were treated with hepatectomy and non-hepatectomy respectively.The imaging features,surgical treatment scheme,postoperative complications,residual rate of stones,recurrence rate and comprehensive treatment effect of hepatectomy group and non-hepatectomy group were analyzed.The relationship between residual stone rate,recurrence rate and surgical method was analyzed,and the results were statistically analyzedResults:According to the classification principle of intrahepatic cholelithiasis in the choledocholithiasis group of the Chinese Society of surgery,all patients were divided into type 1(26 cases)?type ?(52 cases)?type 111(38 cases),the operation was divided into hepatectomy group(96 cases)and non-hepatectomy group(20 cases)(bile duct drainage or common bile duct cutting+T-tube drainage.In the case of these three types of right hepatic bile duct stone,96 cases of the hepatectomy group,the complication rate(incision infection,lung infection,bile leakage,abdominal hemorrhage,etc.)was 40.6%;the residual stone rate was 27%;the recurrence rate was 15.7%;and the excellent and good rate was 71%.20 cases of the non-hepatectomy group,the complication rate was 15%;the residual stone rate was 80%;the recurrence rate was 75%;and the excellent and good rate was 25%.The postoperative complication rate of the hepatectomy group was higher than that of the the non-hepatectomy group(X2=4.706,P=0.03),but the postoperative residual stone rate(P<0.001)and the recurrence rate(P=0.003)were significantly lower than that of the latter,and the operation and good rate of the hepatectomy group was significantly superior to that of the non-hepatectomy group(X2=14.905,P<0.001).Conclusion:Hepatectomy has its definite indication in the treatment of right intrahepatic cholelithiasis.For patients who meet the indication of hepatectomy,hepatectomy should be carried out actively.Before hepatectomy,liver function should be positively evaluated and combined with imaging examination to determine the size and scope of hepatectomy.For lesion confined to regular segments of the liver,regular hepatectomy should be selected to minimize surgical complications;Attention should be paid to the use of intraoperative color Doppler ultrasound,intraoperative choledochoscopy and other surgical tools,so as to reduce the residual stone rate and recurrence rate as much as possible,so as to ensure that the patients get better surgical results.