| Objective: Hepatectomy is the most effective treatment for hepatolithiasis(HL)except liver transplantation.The safety and clinical effect of laparoscopic hepatectomy(LH)for HL is still controversial in China,and the results reported in many literatures often contradictory.The treatment of HL still puzzles surgeons.The aim of the study was to explore the safety,feasibility and effectiveness of LH in the treatment of intrahepatic bile duct stones.Methods: A total of 233 consecutive patients with HL who met the inclusion and exclusion criteria were selected from December 2017 to January 2022,admitted to the Department of Hepatobiliary Surgery,Yijishan Hospital,Wannan Medical College.The clinical records of the enrolled patients were reviewed and summarized,and the baseline data of the patients were matched 1:1 using the Propensity Socre Matching(PSM)method.The safety and feasibility of clinical application of LH for HL were evaluated by comparing the relevant indicators such as operation time,intraoperative blood loss,intraoperative blood transfusion rate,immediate ICU admission rate,grade of complications occurring,and total hospitalization cost of the two groups.The effectiveness of the technique was evaluated by comparing postoperative recovery time of gastrointestinal funtion,postoperative hospital stay,stone clearance rate,recurrence rate.Results: There were 112 successful matched patients,45 male patients(40.18%)and67 female patients(59.82%).The operative time was significantly longer in the LH group than in the OH group [(304.21±103.03 min)versus(260.36±77.51 min),P =0.014 ].The median intraoperative bleeding volume was less in the LH group than in the OH group(100 ml vs.200 ml,P = 0.003).The cases of intraoperative blood transfusion in the LH group [12.5%(7/56)versus 19.6%(11/56),P = 0.303],and immediate postoperative ICU admission rate [5.3%(3/56)versus 7.1%(4/56),P =0.768] was less in the LH group.The percentage of grade I-IV complications in the LH group were significantly lower than those in the OH group {[14.3%(8/56),1.8%(1/56),1.8%(1/56),5.4%(3/56)] versus [37.5%(21/56),3.6%(2/56),3.6%(2/56),7.1%(4/56)],P = 0.035}.The postoperative recovery time of gastrointestinal funtion was faster in the LH group [(1.96±0.11)d vs.(2.70±0.17)d,P = 0.002],and the postoperative hospital stay was shorter n the LH group [(8.79±0.40)d vs.(10.36±0.55)d,P = 0.020].The initial stone clearance rate was 76.7%(43/56)in the LH group and 83.9%(47/56)in the OH group(P > 0.05).The final stone removal rate was 85.7%(48/56)in the LH group compared with 89.3%(50/56)in the OH group(P > 0.05),and the stone recurrence rate was 12.5(7/56)compared with10.71%(6/56)in the LH group compared with the OH group(P > 0.05).The above results suggest that LH can be safely and effectively used in the treatment of HL,and the recovery rate after surgery was faster in the LH group.Conclusion: For selected patients with HL,LH was able to reduce intraoperative bleeding,decrease the risk of complications,and accelerate postoperative recovery;the stone removal rate and stone recurrence rate,were similar to those of OH.LH is a safety and effective treatment method that deserves to be popularized. |
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