| Objective:To analyze the therapeutic effect of partial hepatectomy combined with intraoperative andpostoperative choledochofiberscopy for treating intrahepatic bile duct stones.Methods:Totally 31 clinical cases with hepatolithiasis who were hospitalized in our departments fromJanuary, 2006 to December, 2009 were collected. The clinical datas of all patients weresummarized, including age, gender, clinical symptoms, past medical history, stone distribution,preoperative direct bilirubin, albumin, operative technique, operation time, blood loss, hospitalstay, residual stone rate, complications and mortality. Univariate Logistic Regression Analysiswas used to analyze the risk factors may lead to postoperative residual stone and postoperativecomplications. All patients were followed up after surgery through return visit or telephonecounseling. Referenced to the evaluation of surgical treatment of hepatolithiasis summarized bythe Huang Zhiqiang. The results were divided into four grades, including excellent, good, badand death. If the patient had no clinical symptoms, and can work normally, was classified asexcellent grade. If the patient had mild symptoms of cholangitis occasionally, but he cancontinued a normal life and work, was classified as good grade. If the patient s symptoms ofcholangitis were improved, but they were still frequently attack, or the patient requiredre-hospitalization even need to re-operation, and can not have a normal life and work, wasclassified as bad grade. If the patient died during the follow-up, need to ascertain the cause ofdeath whether the complications or other diseases.Result:Recent therapeutic effect1. Operation time: 170min 480min, average operation time (251±63) min. Hemorrhagicvolume: 80ml 1100ml average hemorrhagic volume (290±192)ml. Hospital stay: 10d 30d, average hospital stay: (18.8±4.4)d After the operation 19 patients required intravenousinfusion of plasma, the plasma volume: 130ml 1000ml, average plasma volume: (370±217)ml. 3 patients required intravenous infusion of red blood cells after surgery, the redblood cell volume were 2 unit, 2 unit, 8 unit.2. 6 (19.4 ) patients bile duct were stricture, 7(22.6 ) patients left hepatic lobe were atrophy.3. 4(15.6 ) patients had residual stones during surgery, including 3 cases in right lobe and 1 inthe left, which was the muddy stone. There were 8 cases (25.8%) had residual stones, inwhich 2 cases in the left lobe, 6 cases in the right lobe.4. Choledochofiberscope was used to obtain residual stones pass through sinus. Four patientscould be removed all stones in one time, two cases in two times, one case in three times, andone case in five times. Two patients still could not be removed all the stones, of them, one inthe right hepatic duct, and the other one in the left. The final residual stone rate was 6.25%.5. There were 7(22.6 ) patients developed postoperative complications, including 3(9.4 )cases of biliary tract infection, abdominal effusion in 3(9.4 ) cases, and 1(3.1 ) case ofpulmonary infection.jPostoperative follow-up results:All the patients were followed up between 3 to 44 months. Reference to evaluation methodsby Huang Zhiqiang, and the total effective rate was 93.5%. One patient died ofcholangiocarcinoma after 6 months.Conclusion:Partial hepatectomy combined with intraoperative and postoperative choledochofiberscopyfor treating intrahepatic bile duct stones can achieve good clinical results, but it still has a certainincidence of residual stone. It needs to expand the extent of liver resection and combines withpartial hepatectomy, intraoperative and postoperative choledochofiberscopy and anti-infection toachieve the best results. |
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