Efficacy Evaluation And Strategy Analysis Of Three Surgical Methods For Hepatolithiasis:A Single Institution Experience

Objectives: To evaluate the efficacy of three surgical procedures(open hepatectomy,laparoscopic hepatectomy and percutaneous transhepatic cholangioscopic lithotripsy)for hepatolithiasis based on a single center experience,and to provide clinical treatment strategies.Methods: The clinical data of 205 patients with hepatolithiasis admitted to the Second Affiliated Hospital of Kunming Medical University from January 2017 to January 2021 were retrospectively collected and analyzed.Among them,94 patients who underwent open hepatectomy were included in the OH group,71 patients who underwent laparoscopic hepatectomy were included in the LH group,and 40 patients who underwent percutaneous transhepatic cholangioscopic lithotripsy were included in the PTCSL group.The preoperative data of the three groups were statistically analyzed and compared: general data,surgical history,complications,stone classification;intraoperative data: extent of hepatectomy,operation time,intraoperative blood loss,and hospital stay;postoperative data: complications,residual stones,recurrent stones,intrahepatic cholangiocarcinoma.Results: Preoperative data: the PTCSL group had more patients with previous surgery history than the OH and LH groups,the PTCSL group had more patients with type IIa stones than the OH and LH groups,the LH group had more patients with type IIb stones than the OH and PTCSL groups,and the OH and LH groups had more patients with type E stones than the PTCSL group(all P < 0.001).Intraoperative data:the operation time,intraoperative blood loss,and hospital stay in the PTCSL group were less than those in the OH and LH groups,and the intraoperative blood loss and hospital stay in the LH group were shorter than those in the OH group(all P < 0.001).Postoperative data: after a single operation,the residual stone rate in the OH group and the PTCSL group was significantly higher than that in the LH group(P < 0.001).The stone recurrence rate in PTCSL group was higher than that in LH group(P <0.05).Nine patients in the PTCSL group had no history of hepatobiliary surgery,and no stone recurrence was observed after single or multiple PTCSL treatments.Multivariate Logistic regression analysis showed that surgical histor and residual stones after multiple operations were risk factors for stone recurrence.Conclusions: OH,LH and PTCSL are safe and effective for hepatolithiasis.Patients with high risk of open or laparoscopic hepatectomy can be treated with PTCSL after evaluation,which is minimally invasive and highly reproducible.PTCSL is feasible for patients initially diagnosed with hepatolithiasis,which does not increase the recurrence rate of stones.The combination of multidisciplinary team and reasonable application of a variety of minimally invasive techniques can provide accurate,minimally invasive and individualized treatment for patients with hepatolithiasis.