Clinical Study On Laparoscopic Left Hepatectomy Combined With Biliary Tract Exploration Via Left Hepatic Duct Orifice In The Treatment Of Hepatic Calculus

Objective: To evaluate the effectiveness and security of hepatic calculus elimination by laparoscopic left hepatectomy combined with cholangioscopy via the left hepatic duct(LHD)orifice.Methods: Clinical data of 69 cases of the Second Affiliated Hospital of Nanchang University from March 2016 to March 2019 were retrospectively reviewed,these patients suffered from left-sided hepatolithiasis,and some of them with common bile duct stones,all the patients completed Laparoscopic Left Hepatectomy and cholangioscopy.According to the difference of surgical procedures,these patients were divided into two groups: observation group(LHD group)and control group(CBD group).In observation group,36 patients underwent left hepatectomy with intraoperative biliary exploration via the left hepatic duct(LHD)orifice.As control group,33 patients underwent left hepatectomy,common bile duct(CBD)exploration and T tube drainage.The primary outcome measures included overall operative time,intraoperative bleeding volume,postoperative hospitalization duration,residual calculi,treatment cost,frequency of procedure-related complications and etc.Results: The operative time(249.39±77.83 min vs 303.64±68.33 min),postoperative hospitalization time(11.14±2.43 d vs 12.58±2.25 d)and hospitalization cost(54363.65±12203.81 RMB vs 65778.59±11306.07 RMB)of observation group were significant lower than that of control group(P<0.05),the albumin levels on the7 th day after surgery(35.17±3.30 g/L vs 32.36±3.98 g/L)is higher in observation group(P<0.05).there were no significant differences in intraoperative bleeding volume,incidence of bile leakage,hepatic failure,abdominal infection,incisional infection and total complications in 2 groups(P>0.05).In 69 patients,63 cases were followed-up(91.3%),All the patients had no stone recurrence.2 patients in control group had residual calculi,while no one occurred in observation group,and there was no significant differences in two groups(P>0.05).Conclusions: Lithotomy using cholangioscopy via left hepatic duct orifice after laparoscopic left hepatectomy is an effective and safe method to treat left hepatolithiasis,it could not only shortening the postoperative hospitalization time and operation time,but also simplified operation procedures that avoided complications of choledochotomy and T-tube drainage,it really reduced hospitalization expenses and improved patients’ postoperative quality of life.