Clinical Application on Hepatectomy Combined with Biliary Tract Exploration via The Bile Duct Stump in Treatment of Hepatolithus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 HUANGZhi , PENGSha-sha , DUANJian , HUANGHan-fei , LINJie , SUZi-ting ,  ZENGZhong

Organ Transplantation Center, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China;

Corresponding author：

ZENGZhong, Email: zzong@medmail.com.cn

Keywords：

Hepatolithiasis; Common bile duct incision; Choledochoscopic exploration; Left hepatic lobectomy

DOI：

10.7507/1007-9424.20140287

Video：

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Objective To evaluate the feasibility and effect of treatment of bile duct exploration though hepatic sections instead of spliting common bile duct, cured for hepatolithiasis with bile duct stones. Methods Clinical data of 122 cases of our hospital were retrospectively reviewed, these patients with left intrahepatic bile duct stone and common bile duct calculi. As control group, during the period from June 2007 to June 2010, in which 64 patients underwent left hepatic lobectomy, common bile duct exploration and T tube drainage. In observation group, 58 patients from June 2011 to December 2013, underwent left hepatic resection combined biliary duct exploration by the liver section stump bile duct. The operative time, intraoperative bleeding volume, postoperative hospitalization time, and incidence of complications between the 2 groups were compared. Results Compared with the control group, the postoperative hospitalization time was shortened obviously in observation group patients(P < 0.05), there were no significant difference in operative time and bleeding during operation of 2 groups(P > 0.05), The incidence of postoperative complications in the observation group was significantly lower than the control group(P < 0.05). In 122 patients, 105 cases were followed-up(86.1%), the follow-up time was 2 years. Two groups of patients had no stone residual and recurrence. Conclusions Bile duct exploration by intraoperative liver section is an effective method to treat left hepatolithiasis, it can simplified procedures, shortening the postoperative hospitalization time, and effectively avoid complications caused by common bile duct incision and T tubedrainage.

Citation： HUANGZhi, PENGSha-sha, DUANJian, HUANGHan-fei, LINJie, SUZi-ting, ZENGZhong. Clinical Application on Hepatectomy Combined with Biliary Tract Exploration via The Bile Duct Stump in Treatment of Hepatolithus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1194-1197. doi: 10.7507/1007-9424.20140287 Copy

1.	Agarwal N, Sharma BC, Garg S, et al. Endoscopic management of postoperative bile leaks[J]. Hepatobiliary Pancreat Dis Int, 2006, 5(2):273-277.
2.	Tazuma S. Gallstone disease:epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)[J]. Best Pract Res Clin Gastroenterol, 2006, 20(6):1075-1083.
3.	Sato M, Watanabe Y, Horiuchi S, et al. Long term results of hepatic resection for hepatolithiasis[J]. HPB Surg, 1995, 9(1):37-41.
4.	Cheung MT, Kwok PC. Liver resection for intrahepatic stones[J]. Arch Surg, 2005, 140(10):993-997.
5.	Uchiyama K, Kawai M, Ueno M, et al. Reducing residual and recurrent stones by hepatectomy for hepatolithiasis[J]. J Gastrointest Surg, 2007, 11(5):626-630.
6.	黄志强, 黄晓强, 张文智, 等.肝切除术治疗肝内胆管结石20年的演变[J].中华外科杂志, 2008, 46(19):1450-1452.
7.	Sikic N, Tutek Z, Strikic N. Primary suture vs. T-tube after common bile duct exploration (our 25 years of experience)[J]. Przegl Lek, 2000, 57(5):143-145.
8.	Haq A, Morris J, Goddard C, et al. Delayed cholangitis resulting from a retained T-tube fragment encased within a stone:a rare complication[J]. Surg Endosc, 2002, 16(4):714.
9.	徐云峰, 王凯, 刘亚奇, 等.原发性肝内胆管结石合并胆管癌[J].中华普通外科杂志, 2012, 27(2):145-147.
10.	Park HS, Lee JM, Kim SH, et al. CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis[J]. AJR Am J Roentgenol, 2006, 187(2):445-453.
11.	Kayhan B, Akdogan M, Parlak E, et al. Hepatolithiasis:a Turkey experience[J]. Turk J Gastroenterol, 2007, 18(1):28-32.
12.	Kim YT, Byun JS, Kim J, et al. Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis[J]. Hepatogastroenterology, 2003, 50(49):8-12.
13.	董家鸿, 黄志强, 蔡景修, 等.规则性肝段切除术治疗肝内胆管结石病[J].中华普通外科杂志, 2002, 17(7):418-420.
14.	黄志强.肝内胆管结石外科治疗的进展[J].中国实用外科杂志, 2004, 24(2):65-66.
15.	Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases:analysis of 1222 consecutive patients from a prospective database[J]. Ann Surg, 2004, 240(4):698-708.
16.	Lee SG, Hwang S. How I do it:assessment of hepatic functional reserve for indication of hepatic resection[J]. J Hepatobiliary Pancreat Surg, 2005, 12(1):38-43.
17.	杨一屯, 陈小伟, 杨森华, 等.肝胆管结石280例外科治疗的变迁[J].中华肝胆外科杂志, 2003, 10(2):65-68.
18.	Hwang S, Lee SG, Kim MH, et al. Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis[J]. Langenbecks Arch Surg, 2008, 393(3):383-389.
19.	谭志健, 何军明, 钟小生, 等.肝外段肝静脉的控制与选择性肝血流阻断在肝切除术中的运用[C]//第五届中西医结合围手术期医学研讨会论文集.杭州, 2010:79-82.
20.	董玉玺, 李德旭, 金俊硕, 等.选择性肝血流阻断法在切肝术中应用研究[J].中华实用诊断与治疗杂志, 2014, 28(3):244-255.
21.	王德盛, 窦科峰, 高志清.复杂性肝内胆管结石的外科综合治疗[J].中华肝胆外科杂志, 2004, 10(4):273-274.
22.	梁力建, 李绍强.复杂肝胆管结石诊断和治疗原则[J].中国实用外科杂志, 2009, 29(7):542-544.
23.	Kim MJ, Michell DG, Ito k, et al. Billiary dilatation:differentiaion of benign from malignant causes value of adding conventional MR imaging tom MR cholangiopancreatography[J]. Radiology, 2000, 214(1):173-181.
24.	Sica GT, Brarer J, Cooney MJ, et al. Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis[J]. Radiology, 1999, 210(3):605-610.
25.	陈照宏, 陈志安. MRCP对复杂型胆道结石的诊断价值[J].医学影像学杂志, 2013, 23(3):434-436.

1. Agarwal N, Sharma BC, Garg S, et al. Endoscopic management of postoperative bile leaks[J]. Hepatobiliary Pancreat Dis Int, 2006, 5(2):273-277.
2. Tazuma S. Gallstone disease:epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic)[J]. Best Pract Res Clin Gastroenterol, 2006, 20(6):1075-1083.
3. Sato M, Watanabe Y, Horiuchi S, et al. Long term results of hepatic resection for hepatolithiasis[J]. HPB Surg, 1995, 9(1):37-41.
4. Cheung MT, Kwok PC. Liver resection for intrahepatic stones[J]. Arch Surg, 2005, 140(10):993-997.
5. Uchiyama K, Kawai M, Ueno M, et al. Reducing residual and recurrent stones by hepatectomy for hepatolithiasis[J]. J Gastrointest Surg, 2007, 11(5):626-630.
6. 黄志强, 黄晓强, 张文智, 等.肝切除术治疗肝内胆管结石20年的演变[J].中华外科杂志, 2008, 46(19):1450-1452.
7. Sikic N, Tutek Z, Strikic N. Primary suture vs. T-tube after common bile duct exploration (our 25 years of experience)[J]. Przegl Lek, 2000, 57(5):143-145.
8. Haq A, Morris J, Goddard C, et al. Delayed cholangitis resulting from a retained T-tube fragment encased within a stone:a rare complication[J]. Surg Endosc, 2002, 16(4):714.
9. 徐云峰, 王凯, 刘亚奇, 等.原发性肝内胆管结石合并胆管癌[J].中华普通外科杂志, 2012, 27(2):145-147.
10. Park HS, Lee JM, Kim SH, et al. CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis[J]. AJR Am J Roentgenol, 2006, 187(2):445-453.
11. Kayhan B, Akdogan M, Parlak E, et al. Hepatolithiasis:a Turkey experience[J]. Turk J Gastroenterol, 2007, 18(1):28-32.
12. Kim YT, Byun JS, Kim J, et al. Factors predicting concurrent cholangiocarcinomas associated with hepatolithiasis[J]. Hepatogastroenterology, 2003, 50(49):8-12.
13. 董家鸿, 黄志强, 蔡景修, 等.规则性肝段切除术治疗肝内胆管结石病[J].中华普通外科杂志, 2002, 17(7):418-420.
14. 黄志强.肝内胆管结石外科治疗的进展[J].中国实用外科杂志, 2004, 24(2):65-66.
15. Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases:analysis of 1222 consecutive patients from a prospective database[J]. Ann Surg, 2004, 240(4):698-708.
16. Lee SG, Hwang S. How I do it:assessment of hepatic functional reserve for indication of hepatic resection[J]. J Hepatobiliary Pancreat Surg, 2005, 12(1):38-43.
17. 杨一屯, 陈小伟, 杨森华, 等.肝胆管结石280例外科治疗的变迁[J].中华肝胆外科杂志, 2003, 10(2):65-68.
18. Hwang S, Lee SG, Kim MH, et al. Intraoperative biliary exploration through the left hepatic duct orifice during left hepatectomy in patients with left-sided hepatolithiasis[J]. Langenbecks Arch Surg, 2008, 393(3):383-389.
19. 谭志健, 何军明, 钟小生, 等.肝外段肝静脉的控制与选择性肝血流阻断在肝切除术中的运用[C]//第五届中西医结合围手术期医学研讨会论文集.杭州, 2010:79-82.
20. 董玉玺, 李德旭, 金俊硕, 等.选择性肝血流阻断法在切肝术中应用研究[J].中华实用诊断与治疗杂志, 2014, 28(3):244-255.
21. 王德盛, 窦科峰, 高志清.复杂性肝内胆管结石的外科综合治疗[J].中华肝胆外科杂志, 2004, 10(4):273-274.
22. 梁力建, 李绍强.复杂肝胆管结石诊断和治疗原则[J].中国实用外科杂志, 2009, 29(7):542-544.
23. Kim MJ, Michell DG, Ito k, et al. Billiary dilatation:differentiaion of benign from malignant causes value of adding conventional MR imaging tom MR cholangiopancreatography[J]. Radiology, 2000, 214(1):173-181.
24. Sica GT, Brarer J, Cooney MJ, et al. Comparison of endoscopic retrograde cholangiopancreatography with MR cholangiopancreatography in patients with pancreatitis[J]. Radiology, 1999, 210(3):605-610.
25. 陈照宏, 陈志安. MRCP对复杂型胆道结石的诊断价值[J].医学影像学杂志, 2013, 23(3):434-436.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Clinical Application on Hepatectomy Combined with Biliary Tract Exploration via The Bile Duct Stump in Treatment of Hepatolithus

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