BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)inc...BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.展开更多
Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an impo...Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an important role in hepatoli-thiasis pathogenesis.A high cholesterol diet is one of the significant reasons for the increasing incidence of hepatolithiasis.Therefore,regular diet and appropriate medical intervention are crucial measures to prevent hepatolithiasis and reduce recurrence rate after surgery.Reducing dietary cholesterol and drugs that increase cholesterol stone solubility are key therapeutic approaches in treating hepato-lithiasis.This article discusses the cholesterol metabolic pathways related to the pathogenesis of hepatolithiasis,as well as food intake and targeted therapeutic drugs.展开更多
BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for lap...BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).展开更多
BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery o...BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery offers comparable safety and efficacy to open surgery,with added benefits in recovery outcomes.AIM To compare clinical outcomes between laparoscopic and open approaches in complex hepatolithiasis.METHODS This retrospective cohort study was conducted at Ningde Municipal Hospital,a tertiary care center,and included 80 patients with complex hepatolithiasis treated between January 2020 and August 2024.Patients were non-randomly allocated to laparoscopic(n=40)or open surgery(n=40)groups based on the treatment period.Clinical,intraoperative,and postoperative data were analyzed using appropriate parametric or nonparametric tests;categorical data were analyzed using χ^(2) or Fisher’s exact test.RESULTS Laparoscopic surgery was associated with a longer median operative time(250.0 minutes vs 207.0 minutes,P=0.003)but shorter postoperative hospital stay(9.0 days vs 14.0 days,P<0.001)compared to open surgery.Wound infection rates were significantly less frequent in the laparoscopic group(5.0%vs 22.5%,P=0.023).Stone clearance rates and overall complications were comparable.One case of perioperative mortality occurred in the open surgery cohort.CONCLUSION Laparoscopic surgery is a feasible and safe alternative to open surgery for complex hepatolithiasis,offering faster recovery and reduced wound-related complications.展开更多
In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct...In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.展开更多
BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL...BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique enables the clearing of intrahepatic stones and the resolution of strictures.However,hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL.DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation.The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.AIM To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis,and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.METHODS The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected.The patients were divided into two groups:DynaCT-PTOBF group(70 patients)and conventional PTOBF group(70 patients).These groups were compared in terms of the preoperative bile duct stenosis,location of the liver segment where the stone was located,intraoperative operative time,immediate stone retrieval rate,successful stenosis dilatation rate,postoperative complication rate,postoperative reoperation rate,stone recurrence rate,and stenosis recurrence rate.RESULTS DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients.The DynaCTPTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group.Compared with the PTOBF group,the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate(68.6%vs 50.0%,P=0.025),greater immediate stenosis dilatation success rate(72.9%vs 55.7%,P=0.034),greater final stenosis release rate(91.4%vs 75.7%,P=0.012),shorter duration of intraoperative hemorrhage(3.14±2.00 vs 26.5±52.1,P=0.039),and lower incidence of distant cholangitis(2.9%vs 11.4%,P=0.49).There were no significant differences between the two groups in terms of the final stone removal rate,reoperation rate,or long-term complication incidence rate.CONCLUSION DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate.It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.展开更多
Although the incidence of hepatolithiasis is decreasing as the pattern of gallstone disease changes in Asia, the prevalence of hepatolithiasis is persistently high, especially in Far Eastern countries. Hepatolithiasis...Although the incidence of hepatolithiasis is decreasing as the pattern of gallstone disease changes in Asia, the prevalence of hepatolithiasis is persistently high, especially in Far Eastern countries. Hepatolithiasis is an established risk factor for cholangiocarcinoma(CCA), and chronic proliferative inflammation may be involved in biliary carcinogenesis and in inducing the upregulation of cell-proliferating factors. With the use of advanced imaging modalities, there has been much improvement in the management of hepatolithiasis and the diagnosis of hepatolithiasis-associated CCA(HLCCA). However, there are many problems in managing the strictures in hepatolithiasis and differentiating them from infiltrating types of CCA. Surgical resection is recommended in cases of single lobe hepatolithiasis with atrophy, uncontrolled stricture, symptom duration of more than 10 years, and long history of biliaryenteric anastomosis. Even after resection, patients should be followed with caution for development of HL-CCA, because HL-CCA is an independent prognostic factor for survival. It is not yet clear whether hepatic resection can reduce the occurrence of subsequent HL-CCA. Furthermore, there are no consistent findings regarding prediction of subsequent HL-CCA in patients with hepatolithiasis. In the management of hepatolithiasis, important factors are the reduction of recurrence of cholangitis and suspicion of unrecognized HL-CCA.展开更多
AIM: To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis. METHODS: From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met th...AIM: To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis. METHODS: From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met the inclusion criteria for LLH were treated in our institute. Of the 61 patients with hepatolithiasis, 28 underwent LLH (LLH group) and 33 underwent open left hepatectomy (OLH group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, postoperative hospital stay time, stone clearance and recurrence rate were retrospectively analyzed and compared between the two groups. RESULTS: LLH was successfully performed in 28 patients. The operation time of LLH group was longer than that of OLH group (158 ± 43 min vs 132 ± 39 min, P < 0.05) and the hospital stay time of LLH group was shorter than that of OLH group (6.8 ± 2.8 d vs 10.2 ± 3.4 d, P < 0.01). No difference was found in intraoperative blood loss (180 ± 56 mL vs 184 ± 50 mL), postoperative complication rate (14.2% vs 15.2%), and stone residual rate (intermediate rate 17.9% vs 12.1% and final rate 0% vs 0%) between the twogroups. No perioperative death occurred in either group. Fifty-seven patients (93.4%) were followed up for 2-40 mo (mean 17 mo), including 27 in LLH group and 30 in OLH group. Stone recurrence occurred in 1 patient of each group. CONCLUSION: LLH for hepatolithiasis is feasible and safe in selected patients with an equal therapeutic effect to that of traditional open hepatectomy.展开更多
AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane...AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.展开更多
AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 ...AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.展开更多
AIM: To evaluate the feasibility of hepatectomy and primary closure of common bile duct for intrahepatic and extrahepatic calculi. METHODS: From January 2008 to May 2013, anatomic hepatectomy followed by biliary tract...AIM: To evaluate the feasibility of hepatectomy and primary closure of common bile duct for intrahepatic and extrahepatic calculi. METHODS: From January 2008 to May 2013, anatomic hepatectomy followed by biliary tract exploration without biliary drainage(non-drainage group) was performed in 43 patients with intrahepatic and extrahepatic calculi. After hepatectomy, flexible choledochoscopy was used to extract residual stones and observe the intrahepatic bile duct and common bile duct(CBD) for determination of biliary stricture and dilatation. Function of the sphincter of Oddi was determined by manometry of the CBD. Primary closure of the CBD without T-tube drainage or bilioenteric anastomosis was performed when there was no biliary stricture or sphincter of Oddi dysfunction. Dexamethasone and anisodamine were intravenously injected 2-3 d after surgery to prevent postoperative retrograde infection due to intraoperative bile duct irrigation, and to maintain relaxation of the sphincter of Oddi, respectively. During the same period, anatomic hepatectomy followed by biliary tract exploration with biliary drainage(drainage group) was performed in 48 patients as the control group. Postoperative complications and hospital stay were compared between the two groups.RESULTS: There was no operative mortality in either group of patients. Compared to intrahepatic and extrabiliary drainage, hepatectomy with primary closure of the CBD(non-drainage) did not increase the incidenceof complications, including residual stones, bile leakage, pancreatitis and cholangitis(P > 0.05). Postoperative hospital stay and costs were nevertheless significantly less in the non-drainage group than in the drainage group. The median postoperative hospital stay was shorter in the non-drainage group than in the drainage group(11.2 ± 2.8 d vs 15.4 ± 2.1 d, P = 0.000). The average postoperative cost of treatment was lower in the non-drainage group than in the drainage group(29325.6 ± 5668.2 yuan vs 32933.3 ± 6235.1 yuan, P = 0.005). CONCLUSION: Hepatectomy followed by choledochoendoscopic stone extraction without biliary drainage is a safe and effective treatment of hepatolithiasis combined with choledocholithiasis.展开更多
AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic...AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.展开更多
AIM:To evaluate the importance of sphincter of Oddi laxity (SOL) in hepatolithiasis (HL).METHODS:Subjects included 98 patients diagnosed with HL between 2002 and 2007. Detailed histories were taken and the subjects we...AIM:To evaluate the importance of sphincter of Oddi laxity (SOL) in hepatolithiasis (HL).METHODS:Subjects included 98 patients diagnosed with HL between 2002 and 2007. Detailed histories were taken and the subjects were monitored until July 2008. HL patients were divided into two groups:Group included 45 patients with SOL,and Group included 53 patients without. Recurrence and reoperation indices of both groups were calculated and compared.RESULTS:The recurrence index was 0.135 in Group and 0.018 in Group fldex was 0.070 in Group and 0.010 in Group (P <0.001). The mean frequency of biliary operation was 2.07in Group (P = 0.001). Differences between the two groups are significant.CONCLUSION:HL patients with SOL tend to have a higher risk of recurrence and a larger demand for re-operation than those without this condition.展开更多
BACKGROUND:Why 3.3%to 10%of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma(ICC)remains unknown.We carried out a hospital-based case-control study to identify risk factors for the development...BACKGROUND:Why 3.3%to 10%of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma(ICC)remains unknown.We carried out a hospital-based case-control study to identify risk factors for the development of ICC in patients with hepatolithiasis in China.METHODS:Eighty-seven patients with pathologically diagnosed hepatolithiasis associated with ICC and 228 with hepatolithiasis alone matched by sex,age(±2 years),hospital admittance and place of residence were interviewed during the period of 2000-2008.Odds ratios(OR)and 95%confidence intervals(CI)were calculated for each risk factor.RESULTS:Among the patients with hepatolithiasis associated with ICC,the mean age was 57.7 years and 61.0%were female Univariate analysis showed that the significant risk factors for ICC development in hepatolithiasis were smoking,family history of cancer,appendectomy during childhood(under age 20),and duration of symptoms>10 years.In multivariate stepwise logistic regression analysis,smoking(OR=1.931,95%CI:1.000-3.731),family history of cancer(OR=5.175,95%CI:1.216-22.022),and duration of symptoms>10 years(OR=2.34895%CI:1.394-3.952)were independent factors.CONCLUSION:Smoking,family history of cancer and duration of symptoms>10 years may be risk factors for ICC in patients with hepatolithiasis.展开更多
AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.
BACKGROUND: Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis. Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG...BACKGROUND: Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis. Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) technique and applied it in hepatolithiasis patients who had an approximately normal gallbladder and sphincter of Oddi. However, the technique is controversial. In the present study, a canine model was established for hepatocholangioplasty (HC) and hepaticojejunostomy (HJ) to simulate STHG and Roux-en-Y cholangiojejunostomy in the clinic, respectively. Then, the alterations of bile components in the vicinity of the anastomosis were compared. This may provide an experimental guide for choosing an optimal technique for the treatment of hepatolithiasis in the clinic. METHODS: The animals were randomly separated into a control group (5 dogs) and a model group (stenosis of the common bile duct; 24 dogs). The 24 dogs in the model group were randomly divided into an HC group and an HJ group (12/group). Bile was collected from the bile duct at I and 5 months after the operation, and the bile components were determined. RESULTS: The levels of total bile acid, cholesterol, total bilirubin, and phospholipid in the HC group were higher than those in the HJ group (P<0.05). However, no statistical difference was seen in unconjugated bilirubin and calcium ions. The mucin level in bile in the HC group was lower than that in the HJ group at 5 months after the operation (P<0.05). The postoperative lipid peroxidation level was remarkably lower than that in the HJ group (P<0.05). However, the superoxide dismutase level was remarkably higher than that in the HJ group (P<0.05). Finally, a significant difference was found in the positive bacterial culture rate in bile between the groups. CONCLUSION: Changes of bile components near the anastomosis after HC might be more preferable for preventing hepatolithiasis formation than HJ.展开更多
AIM:To investigate clinical features,treatment strategies and outcomes of patients with hepatolithiasis(HL)undergoing surgical treatment,using a new clinicalclassification.METHODS:Sixty-eight HL patients were hospital...AIM:To investigate clinical features,treatment strategies and outcomes of patients with hepatolithiasis(HL)undergoing surgical treatment,using a new clinicalclassification.METHODS:Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December2012 and they were classified into four HL types according to pathological evolution of the disease.These four HL types included typeⅠprimary type(defined as no previous biliary tract surgery),typeⅡinflammatory type(with previous biliary tract surgery and cholangitis),typeⅢmass-forming type(HL complicated by hepatic mass-forming lesion),and typeⅣterminal type(with secondary biliary cirrhosis and resultant portal hypertension).The perioperative data including general information,imaging data,postoperative complications,and immediate and final stone clearance rate were obtained and analyzed.RESULTS:In all 68 patients,the proportion of HL typeⅠ-Ⅳwas 50%(34/68),36.8%(25/68),10.3%(7/68)and 2.8%(2/68),respectively.Abdominal pain was the main clinical manifestation in typeⅠ(88.2%),fever was predominant in typeⅡ(52.0%),the malignancy rate in typeⅢwas high(71.4%),and portal hypertension and spleen enlargement were common in typeⅣ(2/2,100.0%).Liver resection rate for typesⅠ-Ⅲwas 79.4%,72.0%and 71.4%,respectively.The overall incidence of postoperative complications was23.5%(16/68).There were no perioperative deaths.The average length of hospital stay was 12.7±7.3 d.Immediate and final stone clearance rate was 73.5%(50/68)and 89.7%(61/68),respectively.Fifty-nine of68 patients(86.8%)were followed-up for>1 year after surgery,and 96.6%of these patients(57/59)had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life.CONCLUSION:The pathological evolution-based clinical classification of HL has a role in optimizingtreatment strategy,and patients can benefit from thisclassification when it is used properly.展开更多
Primary squamous cell carcinoma(SCC) of the liver is rare and reported sporadically.Up to date,only 24 such cases have been reported in the literature.It is associated with hepatic teratoma,congenital cysts,solitary b...Primary squamous cell carcinoma(SCC) of the liver is rare and reported sporadically.Up to date,only 24 such cases have been reported in the literature.It is associated with hepatic teratoma,congenital cysts,solitary benign non-parasitic hepatic cysts,hepatolithiasis/Caroli's disease or cirrhosis.We reported a case of primary SCC of the liver associated with multiple intrahepatic cholesterol gallstones.The patient underwent hepatectomy followed by radiotherapy,and has survived for over 19 mo without recurrence.展开更多
Because of its complicated pathological features such as repeated cholangitis and multiple operations,hepatolithiasis is difficult to treat and often lead to portal hypertension,and liver failure.The aim of this study...Because of its complicated pathological features such as repeated cholangitis and multiple operations,hepatolithiasis is difficult to treat and often lead to portal hypertension,and liver failure.The aim of this study was to investigate the indications of orthotopic liver transplantation(OLT)for patients with hepatolithiasis and the improvement of operative techniques and the treatment of postoperative complications.METHODS:The data of 4 patients with hepatolithiasis who had undergone OLT at our department in recent years were reviewed retrospectively.RESULTS:The 4 patients with hepatolithiasis complicated with secondary biliary cirrhosis in end-stage liver disease included 1 woman and 3 men.One patient underwent OLT using veno-venous bypass prior to the mobilization of the liver.Two patients were subjected to liver transplantation with improved piggyback technique without bypass.One patient received OLT without bypass.All patients were operated on successfully and recovered uneventfully.Patient 1 had bleeding from the digestive tract on the postoperative day 6.Patient 2 had hemorrhage from the digestive tract and a leakage of end-to-side intestinal anastomosis on the postoperative day 44.Patient 4 was reoperated on because of hemorrhage from the anastomotic stoma of the hepatic artery on the postoperative days 8 and 10.In the 4 patients the mean operative time was 7.9 hours and blood loss was 910 ml.Postoperative pathological analysis revealed biliary liver cirrhosis.Follow-up of all patients showed good conditions.CONCLUSIONS:Hepatolithiasis with secondary biliary liver cirrhosis in patients with end-stage liver disease is indicated for liver transplantation.Veno-venous bypass prior to the mobilization of the liver and improved piggyback tech-nique can lower the incidence of intraoperative bleeding,the duration of surgery and postoperative complications.展开更多
AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without...AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A1： hepatectomy＋HJ; group A2： choledochoctomy＋HJ; group B1： hepatectomy ＋ choledochoctomy T tube drainage; group B2： choledochoctomy ＋ T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures. RESULTS： There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group （0.5% vs 16.7%, P 〈 0.01）. Hepatectomy ＋ choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy ＋ HJ （8.2% vs 22.0%, P = 0.034）. The major reason for postoperative cholangitis was stone residual in the HJ group （16/23, 70.0%）, and stone recurrence in the T tube drainage group （34/35, 97.1%）. The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage. CONCLUSION： The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangi- tis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.展开更多
基金Supported by The Key Research and Development Program of Anhui Province of China,No.1804h08020273The Key Research Project of Health Commission of Anhui Province of China,No.AHWJ2022a016.
文摘BACKGROUND Laparoscopic hepatectomy(LH)has been applied in the treatment of hepatolithiasisa in patients with a history of biliary surgery and has already achieved good clinical outcomes.However,reoperative LH(rLH)includes multiple procedures,and the no studies have examined the clinical value of individual laparoscopic procedures.AIM To evaluate the safety and feasibility of each rLH procedure for hepatolithiasisa in patients with a history of biliary surgery.METHODS Patients with previous biliary surgery who underwent reoperative hepatectomy for hepatolithiasis were studied.Liver resection procedures were divided into three categories:(1)Laparoscopic/open left lateral sectionectomy[reoperative laparoscopic left lateral sectionectomy(rLLLS)/reoperative open left lateral sectionectomy(rOLLS)];(2)Laparoscopic/open left hemihepatectomy[reoperative laparoscopic left hemihepatectomy(rLLH)/reoperative open left hemihepatectomy(rOLH)];and(3)Laparoscopic/open complex hepatectomy[reoperative laparoscopic complex hepatectomy(rLCH)/reoperative open complex hepate ctomy(rOCH)].The clinical outcomes were compared between the rLLLS,rLLH,and rLCH groups,and subgroup analyses were performed for the rLLLS/rOLLS,rLLH/rOLH,and rLCH/rOCH subgroups.RESULTS A total of 185 patients were studied,including 101 rLH patients(40 rLLLS,50 rLLH,and 11 rLCH)and 84 reoperative open hepatectomy(40 rOLLS,33 rOLH,and 11 rOCH).Among the three types of rLH procedure,rLLLS required the shortest operation time(240.0 minutes vs 325.0 minutes vs 350.0 minutes,P=0.001)and the lowest blood transfusion rate(10.0%vs 22.0%vs 54.5%,P=0.005),followed by rLLH.The rLCH had the highest conversion rate(P<0.05)and postoperative intensive care unit stay rate(P=0.001).Most clinical outcomes in rLLLS and rLLH were superior or similar to those in the corresponding open surgery,while there were no differences in all outcomes between the rLCH and rOCH subgroups.CONCLUSION The rLH is safe for hepatolithiasis patients with a history of biliary surgery.The rLLLS and rLLH can be recommended for these patients,whereas rLCH should be applied with caution.
基金Supported by Hebei Natural Science Foundation,No.H2022206539Hebei Provincial Government Funded Clinical Talents Training Project,No.ZF2023143.
文摘Surgical intervention is currently the primary treatment for hepatolithiasis;how-ever,some patients still experience residual stones and high recurrence rates after surgery.Cholesterol metabolism seems to play an important role in hepatoli-thiasis pathogenesis.A high cholesterol diet is one of the significant reasons for the increasing incidence of hepatolithiasis.Therefore,regular diet and appropriate medical intervention are crucial measures to prevent hepatolithiasis and reduce recurrence rate after surgery.Reducing dietary cholesterol and drugs that increase cholesterol stone solubility are key therapeutic approaches in treating hepato-lithiasis.This article discusses the cholesterol metabolic pathways related to the pathogenesis of hepatolithiasis,as well as food intake and targeted therapeutic drugs.
基金Supported by Education Project of Yunnan Province,No.2024J1628and Project of Qujing Medical College in 2024,No.2024XQ002.
文摘BACKGROUND Complex hepatolithiasis has a high perioperative risk and recurrence rate.Currently,standardized treatment protocols and reliable anatomical landmarks remain undefined,posing considerable challenges for laparoscopic hepatectomy in these cases.Achieving complete stone clearance and addressing hilar bile duct stenosis are critical determinants of surgical efficacy in hepatolithiasis management.CASE SUMMARY We present the case of a woman with intrahepatic and extrahepatic bile duct stones and chronic cholangitis who underwent laparoscopic hepatectomy.Hepatic segments I,II,III,IV,VI,and VII of the diseased bile duct tree and bile duct cyst were resected according to the preoperative plan,plastic repair of the hilar bile duct was performed,and the repaired bile duct was anastomosed with the jejunum.The patient achieved a favorable prognosis and long-term survival.CONCLUSION Based on segmental/subsegmental diseased bile duct tree territory hepatectomy and hilar stenosis relief,laparoscopic hepatectomy for complex hepatolithiasis can be safely performed guided by double landmarks(diseased bile duct/hepatic vein).
基金Supported by the Fujian Natural Science Foundation,China,No.2021J011164。
文摘BACKGROUND Laparoscopic surgery is increasingly used for complex hepatolithiasis;however,data on laparoscopic vs open surgery remain limited.This study was undertaken to test the hypothesis that laparoscopic surgery offers comparable safety and efficacy to open surgery,with added benefits in recovery outcomes.AIM To compare clinical outcomes between laparoscopic and open approaches in complex hepatolithiasis.METHODS This retrospective cohort study was conducted at Ningde Municipal Hospital,a tertiary care center,and included 80 patients with complex hepatolithiasis treated between January 2020 and August 2024.Patients were non-randomly allocated to laparoscopic(n=40)or open surgery(n=40)groups based on the treatment period.Clinical,intraoperative,and postoperative data were analyzed using appropriate parametric or nonparametric tests;categorical data were analyzed using χ^(2) or Fisher’s exact test.RESULTS Laparoscopic surgery was associated with a longer median operative time(250.0 minutes vs 207.0 minutes,P=0.003)but shorter postoperative hospital stay(9.0 days vs 14.0 days,P<0.001)compared to open surgery.Wound infection rates were significantly less frequent in the laparoscopic group(5.0%vs 22.5%,P=0.023).Stone clearance rates and overall complications were comparable.One case of perioperative mortality occurred in the open surgery cohort.CONCLUSION Laparoscopic surgery is a feasible and safe alternative to open surgery for complex hepatolithiasis,offering faster recovery and reduced wound-related complications.
文摘In this editorial,we comment on the article by Ye et al.We specifically focused on the novel use of DynaCT biliary soft tissue reconstruction technology in the diagnosis and treatment of hepatolithiasis with bile duct stenosis,which is an innovative approach for enhancing the preoperative evaluation and surgical outcomes in hepatolithiasis.This study also highlights the limitations of conventional imaging techniques such as computed tomography and magnetic resonance cholangiopancreatography,which have low sensitivity for small stones and complex biliary strictures.Given the intricate anatomy of the biliary system and the challenges posed by limited visualization using conventional methods,DynaCT addresses these issues by providing high-resolution,three-dimensional reconstruction of the bile ducts,stones,and vascular structures,thus improving anatomical clarity and enabling precise surgical planning.We also focused specifically on the limitations of DynaCT,such as the need for specialized equipment and patient selection criteria,as well as its advantages and disadvantages compared with conventional PTOBF approaches.Overall,DynaCT represents a significant advancement in hepatolithiasis management,with the potential to become a standard imaging modality for safer and more effective biliary procedures.
文摘BACKGROUND Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts.One-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique enables the clearing of intrahepatic stones and the resolution of strictures.However,hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL.DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation.The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.AIM To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis,and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.METHODS The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected.The patients were divided into two groups:DynaCT-PTOBF group(70 patients)and conventional PTOBF group(70 patients).These groups were compared in terms of the preoperative bile duct stenosis,location of the liver segment where the stone was located,intraoperative operative time,immediate stone retrieval rate,successful stenosis dilatation rate,postoperative complication rate,postoperative reoperation rate,stone recurrence rate,and stenosis recurrence rate.RESULTS DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients.The DynaCTPTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group.Compared with the PTOBF group,the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate(68.6%vs 50.0%,P=0.025),greater immediate stenosis dilatation success rate(72.9%vs 55.7%,P=0.034),greater final stenosis release rate(91.4%vs 75.7%,P=0.012),shorter duration of intraoperative hemorrhage(3.14±2.00 vs 26.5±52.1,P=0.039),and lower incidence of distant cholangitis(2.9%vs 11.4%,P=0.49).There were no significant differences between the two groups in terms of the final stone removal rate,reoperation rate,or long-term complication incidence rate.CONCLUSION DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate.It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.
文摘Although the incidence of hepatolithiasis is decreasing as the pattern of gallstone disease changes in Asia, the prevalence of hepatolithiasis is persistently high, especially in Far Eastern countries. Hepatolithiasis is an established risk factor for cholangiocarcinoma(CCA), and chronic proliferative inflammation may be involved in biliary carcinogenesis and in inducing the upregulation of cell-proliferating factors. With the use of advanced imaging modalities, there has been much improvement in the management of hepatolithiasis and the diagnosis of hepatolithiasis-associated CCA(HLCCA). However, there are many problems in managing the strictures in hepatolithiasis and differentiating them from infiltrating types of CCA. Surgical resection is recommended in cases of single lobe hepatolithiasis with atrophy, uncontrolled stricture, symptom duration of more than 10 years, and long history of biliaryenteric anastomosis. Even after resection, patients should be followed with caution for development of HL-CCA, because HL-CCA is an independent prognostic factor for survival. It is not yet clear whether hepatic resection can reduce the occurrence of subsequent HL-CCA. Furthermore, there are no consistent findings regarding prediction of subsequent HL-CCA in patients with hepatolithiasis. In the management of hepatolithiasis, important factors are the reduction of recurrence of cholangitis and suspicion of unrecognized HL-CCA.
文摘AIM: To explore the feasibility and therapeutic effect of total laparoscopic left hepatectomy (LLH) for hepatolithiasis. METHODS: From June 2006 to October 2009, 61 consecutive patients with hepatolithiasis who met the inclusion criteria for LLH were treated in our institute. Of the 61 patients with hepatolithiasis, 28 underwent LLH (LLH group) and 33 underwent open left hepatectomy (OLH group). Clinical data including operation time, intraoperative blood loss, postoperative complication rate, postoperative hospital stay time, stone clearance and recurrence rate were retrospectively analyzed and compared between the two groups. RESULTS: LLH was successfully performed in 28 patients. The operation time of LLH group was longer than that of OLH group (158 ± 43 min vs 132 ± 39 min, P < 0.05) and the hospital stay time of LLH group was shorter than that of OLH group (6.8 ± 2.8 d vs 10.2 ± 3.4 d, P < 0.01). No difference was found in intraoperative blood loss (180 ± 56 mL vs 184 ± 50 mL), postoperative complication rate (14.2% vs 15.2%), and stone residual rate (intermediate rate 17.9% vs 12.1% and final rate 0% vs 0%) between the twogroups. No perioperative death occurred in either group. Fifty-seven patients (93.4%) were followed up for 2-40 mo (mean 17 mo), including 27 in LLH group and 30 in OLH group. Stone recurrence occurred in 1 patient of each group. CONCLUSION: LLH for hepatolithiasis is feasible and safe in selected patients with an equal therapeutic effect to that of traditional open hepatectomy.
基金Supported by National Natural Science Foundation of China,No.81372243,No.81570593 and No.81370575Key Scientific and Technological Projects of Guangdong Province,No.2014B020228003 and No.2014B030301041+2 种基金Natural Science Foundation of Guangdong Province,No.2015A030312013Science and Technology Planning Project of Guangzhou,No.201400000001-3,No.201508020262 and No.2014J4100128Science and Technology Planning Project of Guangdong Province,No.2017A020215178
文摘AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.METHODS We conducted a systematic literature search on Pub Med,Embase,Web of Science and Cochrane Library,and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy V S conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes(time,estimated blood loss,blood transfusion rate,postoperative intestinal function recovery time,length of hospital stay,postoperative complication rate,initial residual stone,final residual stone and stone recurrence) were analyzed systematically.RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference(WMD): 61.56,95% confidence interval(CI): 14.91-108.20,P = 0.01],lower blood transfusion rate [odds ratio(OR): 0.41,95%CI: 0.22-0.79,P = 0.008],shorter intestinal function recovery time(WMD: 0.98,95%CI: 0.47-1.48,P = 0.01),lower total postoperative complication rate(OR: 0.52,95%CI: 0.39-0.70,P < 0.0001) and shorter stay in hospital(WMD: 3.32,95%CI: 2.32-4.32,P < 0.00001). In addition,our results showed no significant differences between the two groups in operative time(WMD: 21.49,95%CI: 0.27-43.24,P = 0.05),residual stones(OR: 0.79,95%CI: 0.50-1.25,P = 0.31) and stone recurrence(OR: 0.34,95%CI: 0.11-1.08,P = 0.07). Furthermore,with subgroups analysis,our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects. CONCLUSION The laparoscopic approach is safe and effective,with less intraoperative estimated blood loss,fewer postoperative complications,reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.
文摘AIM： To evaluate the efficacy of hilar duct oriented hepatectomy for intractable hepatolithiasis, the ventral hilum exposure （VHE） method that has been applied by the authors. METHODS： From June 1994 to June 2004 for a period of 10 years, 153 patients who had Tsunoda type Ⅲ or Ⅳ hepatolithiasis, received hepatectomy at our institution. Among these patients, 128 who underwent hepatectomy by the VHE method were the subjects for the study. We analyzed the risk of this procedure, residual rate of intrahepatic stones, and stone recurrent rates. RESULTS： The average age was 54.2 years, and the male to female ratio was 1：1.7. The average follow-up period was 25.6 mo （6-114 too）. There was no postoperative severe complication or mortality after the operation. The rate of residual stones was 5.4% and the rate of recurrent stones was 4.2%. CONCLUSION： VHE is a safe surgical procedure and provides favorable treatment results of intractable hepatolithiasis. Especially, this procedure has advantage in that intra-hepatic bile duct stricture may be confirmed and corrected directly during surgery.
基金Supported by Major Program of Science and Technology Bureau of Hainan Province,No.ZDXM2014074Program of Social Development and Scientific and Technological Projects of Hainan Province,No.SF201422Science and Technology Projects of the Education Department of Hainan Province,No.Hjkj2012-25
文摘AIM: To evaluate the feasibility of hepatectomy and primary closure of common bile duct for intrahepatic and extrahepatic calculi. METHODS: From January 2008 to May 2013, anatomic hepatectomy followed by biliary tract exploration without biliary drainage(non-drainage group) was performed in 43 patients with intrahepatic and extrahepatic calculi. After hepatectomy, flexible choledochoscopy was used to extract residual stones and observe the intrahepatic bile duct and common bile duct(CBD) for determination of biliary stricture and dilatation. Function of the sphincter of Oddi was determined by manometry of the CBD. Primary closure of the CBD without T-tube drainage or bilioenteric anastomosis was performed when there was no biliary stricture or sphincter of Oddi dysfunction. Dexamethasone and anisodamine were intravenously injected 2-3 d after surgery to prevent postoperative retrograde infection due to intraoperative bile duct irrigation, and to maintain relaxation of the sphincter of Oddi, respectively. During the same period, anatomic hepatectomy followed by biliary tract exploration with biliary drainage(drainage group) was performed in 48 patients as the control group. Postoperative complications and hospital stay were compared between the two groups.RESULTS: There was no operative mortality in either group of patients. Compared to intrahepatic and extrabiliary drainage, hepatectomy with primary closure of the CBD(non-drainage) did not increase the incidenceof complications, including residual stones, bile leakage, pancreatitis and cholangitis(P > 0.05). Postoperative hospital stay and costs were nevertheless significantly less in the non-drainage group than in the drainage group. The median postoperative hospital stay was shorter in the non-drainage group than in the drainage group(11.2 ± 2.8 d vs 15.4 ± 2.1 d, P = 0.000). The average postoperative cost of treatment was lower in the non-drainage group than in the drainage group(29325.6 ± 5668.2 yuan vs 32933.3 ± 6235.1 yuan, P = 0.005). CONCLUSION: Hepatectomy followed by choledochoendoscopic stone extraction without biliary drainage is a safe and effective treatment of hepatolithiasis combined with choledocholithiasis.
文摘AIM:To compare the outcomes of concomitant cholangiocarcinoma(C-CCA)and subsequent cholangiocar-cinoma(S-CCA)associated with hepatolithiasis. METHODS:From December 1987 to December 2007, 276 patients underwent hepatic resection for hepa-tolithiasis in Changhua Christian Hospital.Sixty-five patients were excluded due to incomplete medical records and the remaining 211 patients constituted our study population base.Ten patients were diag-nosed with C-CCA based on the preoperative biopsy or postoperative pathology.During the follow-up period, 12 patients developed S-CCA.The diagnosis of S-CCA was made by image-guided biopsy or by pathology if surgical intervention was carried out.Patient charts were reviewed to collect clinical information.Parameters such as CCA incidence,interval from operation to CCA diagnosis,interval from CCA diagnosis to disease-related death,follow-up time,and mortality rate were calculated for both the C-CCA and S-CCA groups.The outcomes of the C-CCA and S-CCA groups were math-ematically compared and analysed. RESULTS:Our study demonstrates the clinical implications and the survival outcomes of C-CCA and S-CCA. Among the patients with unilateral hepatolithiasis,the incidence rates of C-CCA and S-CCA were fairly similar (4.8%vs 4.5%,respectively,P=0.906).However,for the patients with bilateral hepatolithiasis,the incidence rate of S-CCA(12.2%)was higher than that of C-CCA (4.7%),although the sample size was limited and the difference between two groups was not statistically sig-nificant(P=0.211).The average follow-up time was 56 mo for the C-CCA group and 71 mo for the S-CCA group.Regard to the average time intervals from operation to CCA diagnosis,S-CCA was diagnosed after 67 mo from the initial hepatectomy.The average time intervals from the diagnoses of CCA to disease-related death was 41 mo for the C-CCA group and 4 mo for the S-CCA group,this difference approached statistical sig-nificance(P=0.075).Regarding the rates of overall and disease-related mortality,the C-CCA group had signifi-cantly lower overall mortality(70%vs 100%,P=0.041) and disease-related mortality(60%vs 100%,P=0.015) than the S-CCA group.For the survival outcomes of two groups,the Kaplan-Meier curves corresponding to each group also demonstrated better survival outcomes for the C-CCA group(log rank P=0.005).In the C-CCA group,three patients were still alive at the time of data analysis,all of them had free surgical margins and did not have pathologically proven lymph node metastasis at the time of the initial hepatectomy.In the S-CCA group,only one patient had chance to undergo a second hepatectomy,and all 12 S-CCA patients had died at the time of data analysis. CONCLUSION:C-CCA has better outcomes than S-CCA.The first hepatectomy is crucial because most patients with recurrent CCA or S-CCA are not eligible for repeated surgical intervention.
基金Supported by Grants from National Natural Science Funds for Distinguished Young Scholars, No. 30925033Science and Technology Planning Project of Zhejiang Province, China, No. 2007C24001
文摘AIM:To evaluate the importance of sphincter of Oddi laxity (SOL) in hepatolithiasis (HL).METHODS:Subjects included 98 patients diagnosed with HL between 2002 and 2007. Detailed histories were taken and the subjects were monitored until July 2008. HL patients were divided into two groups:Group included 45 patients with SOL,and Group included 53 patients without. Recurrence and reoperation indices of both groups were calculated and compared.RESULTS:The recurrence index was 0.135 in Group and 0.018 in Group fldex was 0.070 in Group and 0.010 in Group (P <0.001). The mean frequency of biliary operation was 2.07in Group (P = 0.001). Differences between the two groups are significant.CONCLUSION:HL patients with SOL tend to have a higher risk of recurrence and a larger demand for re-operation than those without this condition.
文摘BACKGROUND:Why 3.3%to 10%of all patients with hepatolithiasis develop intrahepatic cholangiocarcinoma(ICC)remains unknown.We carried out a hospital-based case-control study to identify risk factors for the development of ICC in patients with hepatolithiasis in China.METHODS:Eighty-seven patients with pathologically diagnosed hepatolithiasis associated with ICC and 228 with hepatolithiasis alone matched by sex,age(±2 years),hospital admittance and place of residence were interviewed during the period of 2000-2008.Odds ratios(OR)and 95%confidence intervals(CI)were calculated for each risk factor.RESULTS:Among the patients with hepatolithiasis associated with ICC,the mean age was 57.7 years and 61.0%were female Univariate analysis showed that the significant risk factors for ICC development in hepatolithiasis were smoking,family history of cancer,appendectomy during childhood(under age 20),and duration of symptoms>10 years.In multivariate stepwise logistic regression analysis,smoking(OR=1.931,95%CI:1.000-3.731),family history of cancer(OR=5.175,95%CI:1.216-22.022),and duration of symptoms>10 years(OR=2.34895%CI:1.394-3.952)were independent factors.CONCLUSION:Smoking,family history of cancer and duration of symptoms>10 years may be risk factors for ICC in patients with hepatolithiasis.
文摘AIM: To investigate the feasibility, efficacy and safety of laparoscopic hepaticoplasty using gallbladder as subcutaneous tunnel and sphincter-of-Oddi preservation for hepatolithiasis.
文摘BACKGROUND: Optimal surgical technique plays a key role in preventing the postoperative recurrence of hepatolithiasis. Tian et al developed the subcutaneous tunnel and hepatocholangioplasty using the gallbladder (STHG) technique and applied it in hepatolithiasis patients who had an approximately normal gallbladder and sphincter of Oddi. However, the technique is controversial. In the present study, a canine model was established for hepatocholangioplasty (HC) and hepaticojejunostomy (HJ) to simulate STHG and Roux-en-Y cholangiojejunostomy in the clinic, respectively. Then, the alterations of bile components in the vicinity of the anastomosis were compared. This may provide an experimental guide for choosing an optimal technique for the treatment of hepatolithiasis in the clinic. METHODS: The animals were randomly separated into a control group (5 dogs) and a model group (stenosis of the common bile duct; 24 dogs). The 24 dogs in the model group were randomly divided into an HC group and an HJ group (12/group). Bile was collected from the bile duct at I and 5 months after the operation, and the bile components were determined. RESULTS: The levels of total bile acid, cholesterol, total bilirubin, and phospholipid in the HC group were higher than those in the HJ group (P<0.05). However, no statistical difference was seen in unconjugated bilirubin and calcium ions. The mucin level in bile in the HC group was lower than that in the HJ group at 5 months after the operation (P<0.05). The postoperative lipid peroxidation level was remarkably lower than that in the HJ group (P<0.05). However, the superoxide dismutase level was remarkably higher than that in the HJ group (P<0.05). Finally, a significant difference was found in the positive bacterial culture rate in bile between the groups. CONCLUSION: Changes of bile components near the anastomosis after HC might be more preferable for preventing hepatolithiasis formation than HJ.
基金Supported by Science and Technology Research Project of Anhui Province,China,No.12070403071
文摘AIM:To investigate clinical features,treatment strategies and outcomes of patients with hepatolithiasis(HL)undergoing surgical treatment,using a new clinicalclassification.METHODS:Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December2012 and they were classified into four HL types according to pathological evolution of the disease.These four HL types included typeⅠprimary type(defined as no previous biliary tract surgery),typeⅡinflammatory type(with previous biliary tract surgery and cholangitis),typeⅢmass-forming type(HL complicated by hepatic mass-forming lesion),and typeⅣterminal type(with secondary biliary cirrhosis and resultant portal hypertension).The perioperative data including general information,imaging data,postoperative complications,and immediate and final stone clearance rate were obtained and analyzed.RESULTS:In all 68 patients,the proportion of HL typeⅠ-Ⅳwas 50%(34/68),36.8%(25/68),10.3%(7/68)and 2.8%(2/68),respectively.Abdominal pain was the main clinical manifestation in typeⅠ(88.2%),fever was predominant in typeⅡ(52.0%),the malignancy rate in typeⅢwas high(71.4%),and portal hypertension and spleen enlargement were common in typeⅣ(2/2,100.0%).Liver resection rate for typesⅠ-Ⅲwas 79.4%,72.0%and 71.4%,respectively.The overall incidence of postoperative complications was23.5%(16/68).There were no perioperative deaths.The average length of hospital stay was 12.7±7.3 d.Immediate and final stone clearance rate was 73.5%(50/68)and 89.7%(61/68),respectively.Fifty-nine of68 patients(86.8%)were followed-up for>1 year after surgery,and 96.6%of these patients(57/59)had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life.CONCLUSION:The pathological evolution-based clinical classification of HL has a role in optimizingtreatment strategy,and patients can benefit from thisclassification when it is used properly.
文摘Primary squamous cell carcinoma(SCC) of the liver is rare and reported sporadically.Up to date,only 24 such cases have been reported in the literature.It is associated with hepatic teratoma,congenital cysts,solitary benign non-parasitic hepatic cysts,hepatolithiasis/Caroli's disease or cirrhosis.We reported a case of primary SCC of the liver associated with multiple intrahepatic cholesterol gallstones.The patient underwent hepatectomy followed by radiotherapy,and has survived for over 19 mo without recurrence.
文摘Because of its complicated pathological features such as repeated cholangitis and multiple operations,hepatolithiasis is difficult to treat and often lead to portal hypertension,and liver failure.The aim of this study was to investigate the indications of orthotopic liver transplantation(OLT)for patients with hepatolithiasis and the improvement of operative techniques and the treatment of postoperative complications.METHODS:The data of 4 patients with hepatolithiasis who had undergone OLT at our department in recent years were reviewed retrospectively.RESULTS:The 4 patients with hepatolithiasis complicated with secondary biliary cirrhosis in end-stage liver disease included 1 woman and 3 men.One patient underwent OLT using veno-venous bypass prior to the mobilization of the liver.Two patients were subjected to liver transplantation with improved piggyback technique without bypass.One patient received OLT without bypass.All patients were operated on successfully and recovered uneventfully.Patient 1 had bleeding from the digestive tract on the postoperative day 6.Patient 2 had hemorrhage from the digestive tract and a leakage of end-to-side intestinal anastomosis on the postoperative day 44.Patient 4 was reoperated on because of hemorrhage from the anastomotic stoma of the hepatic artery on the postoperative days 8 and 10.In the 4 patients the mean operative time was 7.9 hours and blood loss was 910 ml.Postoperative pathological analysis revealed biliary liver cirrhosis.Follow-up of all patients showed good conditions.CONCLUSIONS:Hepatolithiasis with secondary biliary liver cirrhosis in patients with end-stage liver disease is indicated for liver transplantation.Veno-venous bypass prior to the mobilization of the liver and improved piggyback tech-nique can lower the incidence of intraoperative bleeding,the duration of surgery and postoperative complications.
文摘AIM： To evaluate the long-term outcome and surgical indications of hepaticojejunostomy （H J） for the treatment of hepatolithiasis. METHODS- Three hundred and fourteen elective cases with hepatolithiasis but without biliary stricture or cystic dilatation treated in the past 10 years were reviewed retrospectively. The patients were divided into HJ group and T tube drainage group according to biliary drainage procedure. Furthermore, four subgroups were subdivided by hepatectomy as a balance factor, group A1： hepatectomy＋HJ; group A2： choledochoctomy＋HJ; group B1： hepatectomy ＋ choledochoctomy T tube drainage; group B2： choledochoctomy ＋ T tube drainage. The stone residual rate, surgical efficacy and long-term outcome were compared among different procedures. RESULTS： There was no surgical mortality among all patients. The total hospital mortality was 1.6%. The overall stone residual rate after surgical clearance was 25.9%. There was no statistical difference between HJ group and T tube drainage group in terms of stone residual rate after surgical clearance, however, after postoperative choledochoscopic lithotripsy, the total stone residual rate of T tube drainage group was significantly lower than that of HJ group （0.5% vs 16.7%, P 〈 0.01）. Hepatectomy ＋ choledochoctomy tube drainage achieved the optimal therapeutic effect, only 8.2% patients suffered from an attack of cholangitis postoperatively, which was significantly lower than that of hepatectomy ＋ HJ （8.2% vs 22.0%, P = 0.034）. The major reason for postoperative cholangitis was stone residual in the HJ group （16/23, 70.0%）, and stone recurrence in the T tube drainage group （34/35, 97.1%）. The operative times were significantly prolonged in those undergoing HJ, and the operative morbidity of HJ was higher than those of T tube drainage. CONCLUSION： The treatment result of HJ for hepatolithiasis is not satisfactory in this retrospective study due to high rate of stone residual and postoperative cholangi- tis. HJ could not drain residual stone effectively. HJ may hinder post-operative choledochoscopic lithotripsy, which is the optimal management for postoperative residual stone. The indications of HJ for hepatolithiasis should be strictly selected.
