Clinical effect of anatomical hepatectomy in treatment of intrahepatic bile duct stones

Objective To investigate the clinical effect of anatomical hepatectomy in the treatment of intrahepatic bile duct stones. Methods A retrospective analysis was performed for the clinical data of 117 patients with intrahepatic bile duct stones who underwent hepatectomy in The Affiliated Hospital of Zunyi Medical College from July 2013 to December 2015. Among these patients,66 underwent anatomical hepatectomy( anatomical hepatectomy group) and 51 underwent irregular hepatectomy( irregular hepatectomy group). The time of operation,intraoperative blood loss,volume of drainage on the day after surgery,serum levels of aspartate aminotransferase( AST),alanine aminotransferase( ALT),and total bilirubin( TBil),and length of postoperative hospital stay were recorded,as well as the patients' general status,liver function parameters,and abdominal ultrasound,and CT or MRI findings from 2 months to 2 years after discharge,to observe the presence or absence of residual stones or stone recurrence. The t- test was used for comparison of continuous data between groups,and the chi- square test was used for comparison of categorical data between groups. Results Compared with the irregular hepatectomy group,the anatomical hepatectomy group had a significantly longer time of operation( 303. 1 ± 51. 6 min vs 246. 5 ± 36. 2 min,t = 6. 963,P < 0. 01),but it had significantly less intraoperative blood loss( 467. 9 ± 80. 6 ml vs 565. 9 ± 92. 0 ml,t = 6. 026,P < 0. 01),a significantly lower volume of drainage on the day after surgery( 212. 6 ± 54. 9 ml vs 358. 3 ± 69. 4 ml,t = 12. 682,P < 0. 01),a significantly lower incidence rate of complications( 10. 6% vs 25. 5%,χ~2= 4. 497,P = 0. 034),a significantly lower rate of postoperative residual stones( 4. 5% vs15. 7%,χ~2= 4. 192,P = 0. 041),and a significantly shorter length of hospital stay( 13. 4 ± 2. 6 d vs 21. 9 ± 3. 2 d,t = 15. 427,P<0. 01). On day 3 after surgery,the anatomical hepatectomy group had significantly lower serum levels of ALT,AST,and TBil than the irregular hepatectomy group( AST: 62. 7 ± 25. 4 U / L vs 114. 8 ± 37. 0 U / L,t = 9. 024,P < 0. 01; ALT: 91. 3 ± 35. 7 U / L vs 149. 5 ± 53. 3 U / L,t =7. 067,P < 0. 01; TBil: 31. 8 ± 10. 4 μmol / L vs 51. 3 ± 14. 3 μmol / L,t = 8. 531,P < 0. 01). Conclusion Under the premise of preserving the function of the residual liver,anatomical hepatectomy can completely remove the lesions and has the features of low residual stone rate,low recurrence rate and rapid postoperative recovery. It has a better clinical effect than irregular hepatectomy.