To evaluate the clinical application value of laparoscopic ultrasonography in laparoscopic hepatectomy in the treatment of hepatolithiasis.

Clinical data of 48 patients with hepatolithiasis undergoing laparoscopic hepatectomy in the Affiliated Hospital of North Sichuan Medical College from March 2014 to February 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. 17 patients were males and 29 females, aged 36-76 years with a median of 56 years. The location and range of stones, bile duct stenosis and distribution of intrahepatic vessels and bile ducts were observed by laparoscopic ultrasonography. Liver resection was performed with the guidance of real-time ultrasound. And choledochoscope was used for the exploration and removal of stones in the remaining liver or intra- and extrahepatic bile ducts.

A totalof 46 patients underwent laparoscopic hepatectomy successfully, 2 cases were converted to laparotomy due to severe abdominal adhesion and hilar bile duct stenosis. Laparoscopic ultrasound-assisted exploration found that 5 cases were with unclear preoperative diagnosis of hepatolithiasis, 4 with differentiated intrahepatic calcification. 2 cases received ultrasound-located removal of stones. The distribution of middle hepatic veins were displayed by intraoperative ultrasound in 23 patients undergoing partial hepatectomy, and hepatic vein injury occurred in 1 case. The mean operation time was (308±146) min, and the intraoperative blood loss was (460±280) ml. No death was observed during the perioperative period. Postoperative complications occurred in 7 cases, including 2 cases of hepatic effusion complicated with infection at the resected liver surface, 3 cases of pleural effusion, 1 case of pulmonary infection, and 1 case of incision infection. Residual stones were found in 4 cases, which were removed completely through T-tube sinus tract at postoperative 8 weeks. Postoperative length of hospital stay was (14±7) d. Hepatolithiasis recurred in 3 cases during the follow-up.

Laparoscopic ultrasonography can be used in laparoscopic hepatectomy for hepatolithiasis to determine the location and range of stones, location of bile duct stenosis, and the distribution of important vessels, such as middle hepatic vein, so as to make a reasonable surgical plan. It can help to reduce the residual stones, the recurrence rate, and to increase the safety and precision of surgery.