ORIGINAL ARTICLE   

Minerva Chirurgica 2019 April;74(2):115-20

DOI: 10.23736/S0026-4733.17.07548-4

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Safety and feasibility analysis of combination therapy of laparoscopic left hepatectomy and choledochoscopy for calculus of the left intrahepatic duct

Honghua WANG, Wenxiong LU, Guobao YANG, Junjun ZHU ✉

Department of General Surgery, People’s Hospital of Xiangshui County, Yancheng, Jiangsu Province, China

BACKGROUND: The aim of this paper was to observe the efficacy of combination therapy of laparoscopic left hepatectomy and choledochoscopy for calculus of left intrahepatic duct.
METHODS: We retrospectively analyzed the clinical data of 76 patients with calculus of left intrahepatic duct who were admitted and diagnosed in this hospital between August 2014 and August 2015. Patients who received the laparotomy for treatment were enrolled into the control group (N.=32), and those who received the combination therapy of laparoscopic left hepatectomy and choledochoscopy were enrolled into the study group (N.=44). The surgical efficacy and the occurrence of surgery complications were compared between the two groups, and the recurrence of calculus was observed in follow-up after the operation.
RESULTS: Comparison of the surgical duration showed no statistically significant difference between the two groups (P>0.05); bleeding amount, evacuation time and length of stay in the study group were less or shorter than those in the control group (P<0.05); the overall incidence rate of surgery complications in the study group was 9.10%, which was lower than the overall incidence rate of surgery complications, 43.75%, in the control group (P<0.05). No statistically significant differences were identified in the comparisons of the levels of albumin (ALB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at 1d before and 10d after operation, hospitalization expenses, and operation fee between the two groups (P>0.05). The average duration of follow-up after operation was 12 months, during which 2 patients in the control group were found with a calculus in a diameter of 0.4 cm in the left intrahepatic duct which was later removed using choledochoscopy followed by the extraction of T duct, and the conditions of patient were well-controlled; no recurrence of calculus was observed in the study group.
CONCLUSIONS: Combination therapy of laparoscopic left hepatectomy and choledochoscopy is worth being promoted in clinical practice of treatment for calculus of intrahepatic duct with various advantages, such as significant effect, small trauma, high safety and reliability, rapid recovery after operation and few recurrences.

KEY WORDS: Bile ducts, intrahepatic - Laparoscopy - Hepatectomy - Treatment outcome