The Operative Points And Safety Analysis Of Relaparoscopic Hepatectomy For Left Hepatic Duct Stones

objective:To explore the Operation Essential and safety of laparoscopic hepatectomy((LH))in the treatment of hepatolithiasis with hepatectomic history.Methods:The clinical records of 43 patients with hepatectomic history and re-hepatectomy for intrahepatic lithiasis in the Department of Hepatobiliary Surgery of the Second Affiliated Hospital of Nanchang University from October 2017 to October 2019 were analyzed retrospectively.all patients underwent hepatobiliary pancreatic MRI+MRCP and / or upper abdominal enhanced CT before operation to confirm the diagnosis of hepatolithiasis.Among them,21 patients underwent Laparoscopic partial hepatectomy plus choledochoscopic exploration of the bile duct,and 22 patients underwent traditional open hepatectomy plus choledochoscopic exploration of the bile duct.The proportion of female patients,age,preoperative white blood cell count,hemoglobin concentration,ALT,AST,direct bilirubin,indirect bilirubin,prothrombin time,intraoperative blood loss,operation time,intraoperative blood transfusion rate,postoperative gastrointestinal function recovery time,duration of postoperative hospital stay and postoperative complication rate,total hospital stay,time of postoperative abdominal cavity drainage tube removal and postoperative analgesic usage rate and total hospitalization cost were compared between laparoscopic surgery group and traditional laparotomy group.Results:The operation of the total of 43 patients were successfully completed in the laparoscopy group and the traditional laparotomy group and they were discharged from the hospital,and there was no death.Four weeks after operation,T-tube cholangiography was performed.No residual stones were found and the stone clearance rate was 100%.There were no significant differences in gender composition,age and preoperative examinations between the two groups(P > 0.05).There were no significant differences in operation time,total hospitalization cost,postoperative gastrointestinal recovery time(P > 0.05).There were significant differences in intraoperative blood loss,intraoperative blood transfusion rate,postoperative complications rate,duration of postoperative hospital stay,time of postoperative abdominal cavity drainage tube removal and postoperative analgesic usage rate and total hospital stay between the two groups(P < 0.05).All patients with indwted T tube returned to the hospital four weeks after surgery for T tube angiography: in the laparoscopic group,2 cases were found to have residual choledocholithiasis,and the stone clearance rate was 90.48%.In the open group,the stone clearance rate was86.36%.Patients with primary suture were asked to return to the hospital for reexamination four weeks after surgery,and liver color ultrasonography or upper abdominal CT examination were performed,but no residual stones were found.Postoperative follow-up ranged from 3 to 24 months(median 14 months),and no patients were lost to follow-up.All patients had good quality of life,and no calculi recurred in 43 patients.Conclusion:For the patients with hepatectomic history and re-hepatectomy for hepatolithiasis,with the full evaluations of general condition of the patients before operation,the patient precise dissection and vascular management during the operation and the sufficient exposure of surgical fields,laparoscopic surgery can benefit patients more than traditional laparotomy.