ObjectiveTo explore the effect of laparoscopic hepatectomy in patients with complex hepatolithiasis.MethodsThe clinical data of 31 patients with complex hepatolithiasis treated by laparoscopic hepatectomy in our hospital from January 2015 to September 2019 were retrospectively analyzed, and the effect was followed up.ResultsTwo cases were converted to open surgery, and the remaining 29 cases successfully completed laparoscopic surgery. The operative time of 31 patients was 185–490 min (260±106) min; the intraoperative bleeding volume was 200–1 300 mL (491±225) mL; the time of hepatic blood flow occlusion was 20–45 min (29±18) min; the time of choledochoscopy was 10–50 min (28±15) min. The scope of hepatectomy includes: Ⅱ, Ⅲ, Ⅵ, and Ⅶ in 14 cases, Ⅰ, Ⅱ, Ⅲ,Ⅵ, and Ⅶ in 8 cases, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 3 cases, Ⅳ, Ⅴ, and Ⅷ in 3 cases, Ⅱ, Ⅲ, Ⅴ, Ⅵ, Ⅶ, and Ⅷ in 2 cases, Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅵ, and Ⅶ in 1 case. The postoperative anal exhaust time was 24–73 h (41.8±15.2) h; postoperative feeding time was 14–23 h, median feeding time was 19 h; postoperative ambulation time was 15–46 h, median ambulation time was 27 h; postoperative drainage tube extraction time was 3–14 d, median drainage tube extraction time was 5 d; postoperative hospitalization time was 6–15 d, median postoperative hospitalization time was 9 d. Twenty-seven patients were followed up for 7 to 63 months, with a median follow-up time of 25 months. The incidence of complications was 19.4% (6/31), according to Claviein classification, there were 2 cases in grade Ⅰ (6.5%), 1 case in grade Ⅱ (3.2%), 3 cases in grade Ⅲa (9.7%).ConclusionLaparoscopic hepatectomy is safe and feasible for the treatment of complex hepatolithiasis, which is performed by a skilled hepatobiliary surgeon.
近年来，胆石症的发病谱已发生了根本性的变迁，一些大城市的胆囊结石发病率逐步增加，过去常见的肝内胆管结石已明显减少； 但多数地区肝内胆管结石发病率仍较高，仍是我国的常见病之一，其治疗也仍是胆道外科中的困难问题。运用现代肝脏外科手术技术，处理肝门部和肝内胆管及血管，获得良好的显露，基本上可达到“解除梗阻，去除病灶，通畅引流”的肝胆管结石外科治疗原则。由于肝内胆管结石本身的复杂性，目前尚无一种手术方式可使所有患者获得满意效果，因此，应根据患者的实际情况采用“个体化治疗方案”。常用的手术方法有胆管探查取石、胆肠引流、肝叶切除术等。根据病情、患者的身体素质、技术条件和病变的性质等综合考虑来决定术式。
Objective To observe the effect of gefitinib on expression of epidermal growth factor receptor (EGFR) in bile duct epithelial cells, and the feasibility of inhibiting hyperplasia of bile duct epithelial cells with gefitinib. Methods Sixty-one patients with hepatolithiasis having to be in hospital for surgery from the First People’s Hospital of Shuangliu county were selected, with 25-65 years old, average 46.92 years. The patients were randomly divided into therapy group and control group. There were 30 cases in therapy group, in which fine duct was placed on lesion bile duct during operation, and through whom gefitinib solution was perfused after operation. There were 31 cases in control group with only T tube drainage after operation. The bile duct sample was obtained respectively during the operation and 6 weeks and 12 weeks after operation. The histology and expression change of EGFR were observed by HE staining, immunohistochemistry and RT-PCR method respectively. Results There were no significant differences in pathohistology changes of bile duct and the EGFR protein and mRNA expression between therapy group and control group during operation. The hyperplasia of epithelium mucosae and submucosal gland in the therapy group were obviously decreased as compared with those in control group, the EGFR mRNA and protein expression in therapy group were weaker than those of control group （Plt;0.05） 6 weeks and 12 weeks after gefitinib treatment. Conclusion EGFR is overexpressed in the chronic proliferative cholangitis, and continuously local application of gefitinib after operation can specifically interrupt the activation and expression of EFGR and then effectively inhibit the hyperplasia of bile duct epithelial cells.
目的 探讨胆源性肝脓肿的诊治方法。方法 对我院2000~2004年期间收治并确诊为胆源性肝脓肿的12例患者进行分析，在应用抗生素和全身支持的前提下，再依据其病变发生、发展的不同阶段采用不同手段治疗。结果 4例急性期患者中2例行急诊胆道引流手术后治愈，另2例转为亚急性期（脓肿融合期）； 6例亚急性期患者均经B超导向下行脓肿穿刺抽脓后注入抗生素治疗后治愈； 4例慢性期患者行脓肿切开引流后治愈。结论 本病在应用广谱抗生素（二联抗生素）和全身支持治疗的前提下，再根据病变不同时期采用不同方法治疗，可获得良好效果。
Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
An retrospective analysis of 112 cases with localized left hepatolithiasis (LLH) treated in our center in recent two decades was made. The results showed: ①Coexisting involvements of both left external hepatic duct (LEHD) and left medial hepatic duct (LMHD) were the most common pathological pattern (83.08%), came next the only LEHD involvement (12.31%). There was no localized LMHD caculi in this group. ②The rate of concomitant LHD stricture was 59.82% and that of LMHD or LEHD were 84.85% and 84.00% respectively, in which severe degrees dominate. ③Lateral segmentectomy was the most common clinical practice for LLH (58.93%), and left lebectomy was much less frequently used (12.50%), although the latter led to a significantly smaller rate of residual (7.14% vs 21.21%) and had a satification follow-up rate of 85.71% being superior to lateral segmentectomy (46.97%), or cholangiojejunostomy (40.00%), bile duct exploration and drainage (0). ④The most common prognostic factors were residual or recurrent stones of LMHD (62.50%) and residual LHD stricture (37.50%). ⑤There was no significant difference between left lobectomy and lateral segmentectomy in length of operation, intraoperative bleeding, and postoperative complications. The results indicate that too much dependence on lateral segmentectomy in the management of LLH is one of the most important factors affecting the longterm results, for which left lobectomy is an applicable and safe therapy of choice.