Comparative Study On Multiple Surgical Methods For Intrahepatic Bile Duct Stones

Objective: To explore the efficacy and safety of laparoscopic partial hepatectomy for the treatment of intrahepatic bile duct stones,open partial hepatectomy for the treatment of intrahepatic bile duct stones,and common bile duct exploration for the treatment of intrahepatic bile duct stones,in order to provide a basis for the selection of surgical treatment methods for different intrahepatic bile duct stones.Methods: The clinical data of patients with intrahepatic bile duct stones who had undergone surgical treatment in the First Affiliated Hospital of Hainan Medical University and the Second Affiliated Hospital of Hainan Medical University from January 2017 to December 2022 were collected,and they were divided into group A(laparoscopic partial hepatectomy),group B(partial hepatectomy),and group C(choledocholithotomy)according to the operation mode.For three groups of patients with preoperative liver function: ALB,ALT,AST,TBIL,DBIL,IBIL;Intraoperative effects: surgical time,intraoperative bleeding volume;Postoperative effects: residual stone rate,electrocardiogram monitoring time,intestinal exhaust time,abdominal drainage time,and liver function on the 7th day after surgery were analyzed.Analyze the above data using statistical methods such as chi square,analysis of variance,Kruskal Wallis H,and Fisher.The test level a=0.05 has statistical significance with P<0.05.Result:(1)Surgical time: Group A<Group B<Group C,with median values of444.00(325.00,574.00),320.00(250.00,348.00),222.0(166.30,272.50),respectively(P<0.05),with statistically significant differences Intraoperative bleeding:Group A<Group B,Group C<Group B(P<0.05),there was no statistically significant difference between Group A and Group C(P>0.05).The median values of Group A,Group B,and Group C were 200.00(100.00,400.00),400.00(200.00,700.00),and100.00(56.50,200.00),respectively.(3)Liver function at 7 days after surgery: The median values of ALB at 7 days after surgery were 33.62(30.73,36.14),30.14(27.35,30.86),and 31.00(28.62,33.86),respectively.Group A was higher than Group B(P<0.05),and there was no statistically significant difference in other liver function indicators(P>0.05)Postoperative electrocardiogram monitoring time: The median values of Group A,Group B,and Group C were 2.00(2.00,2.00),1.00(2.00,3.00),and 2.00(1.00,2.00),respectively,with no statistically significant difference(P>0.05)The median recovery time of postoperative intestinal function was 2.00(1.00,2.00),2.00(1.00,2.00),and 1.50(1.00,2.00),respectively,with no statistically significant difference(P>0.05)Postoperative abdominal drainage time: Median values were 6.00(6.00,8.00),8.00(7.00,9.00),and 5.00(6.50,7.75),respectively.Group A was less than Group B,Group C was less than Group B(P<0.05),and Group A was compared with Group C(P>0.05)Postoperative intra group complications: The incidence rate in Group A was 4.35%,in Group B was 26.32%,and in Group C was 10.00%.There was no statistically significant difference among the three data groups(P>0.05)Residual stone rate: Group A has a residual stone rate of 21.74%,Group B has a residual stone rate of 47.37%,Group C has a residual stone rate of 60.00%,Group A is less than Group C(P<0.05),and there is no statistically significant difference between Group A and Group B,as well as between Group B and Group C(P>0.05).