Clinical efficacy of laparoscopic left hemihepatectomy combined with bile duct exploration via left hepatic duct stump for complex left hepatic bile duct stones complicated with common bile duct stones

doi:10.3877/cma.j.issn.2095-3232.2025016

Abstract

Abstract:

Objective

To evaluate clinical efficacy of laparoscopic left hemihepatectomy combined with bile duct exploration via the left hepatic duct stump for complex left hepatic bile duct stones complicated with common bile duct stones.

Methods

Clinical data of 27 patients with complex left hepatic bile duct stones complicated with common bile duct stones admitted to General Hospital of Central Theater Command from June 2018 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 11 patients were male and 16 female, aged from 31 to 79 years, with a median age of 58 years.12 patients underwent laparoscopic left hemihepatectomy combined with common bile duct exploration via the left hepatic duct stump (laparoscopic group), 15 cases underwent traditional open partial hepatectomy combined with common bile duct exploration and T tube drainage (traditional group).Operation time and postoperative pain score between two groups were compared by t test.The incidence of postoperative complications and stone clearance rate were compared by Fisher's exact test.

Results

Bile duct stones were removed in all patients, and no patient died.Only one case of liver failure occurred in the traditional group.The average operation time, postoperative pain score, length of hospital stay and hospital expense in the laparoscopic group were (276±41) min, 1.3±0.5,(13±3) d and (7.7±1.1)×10⁴ yuan, which were significantly less than (315±49) min, 2.2±0.4, (19±7) d and(9.5±2.7)×10⁴ yuan in the traditional group (t=-2.172, -3.950, -2.885, -2.301; P＜0.05), respectively.1 patient developed incisional infection in the laparoscopic group and 7 cases in the traditional group, and the difference was statistically significant (P＜0.05).In the laparoscopic group, 2 patients presented with postoperative bile leakage and 1 patient experienced stone recurrence, and 3 and 2 cases in the traditional group, with no statistical significance between two groups (P＞0.999).No bile duct injury, stenosis or other adverse events were reported during postoperative follow-up.

Conclusions

Laparoscopic left hemihepatectomy combined with common bile duct exploration via the left hepatic duct stump has multiple advantages, such as high safety and efficacy, minimal invasiveness, rapid postoperative recovery, low incidence of postoperative complications and low hospital expense compared with traditional open surgery.

Key words: Hepatolithiasis, Complicated intrahepatic and extrahepatic bile duct stones, Laparoscopes, Choledochoscope, Safety, Efficacy

Tianji Luan, Ding Cao, Hongliang Mei, Hangwei Fu, Kai Yang, Dan Wang, Zuohong Shang, Feng Ling, Zhihui Li, Zhenyu Zhang, Yilin Hu. Clinical efficacy of laparoscopic left hemihepatectomy combined with bile duct exploration via left hepatic duct stump for complex left hepatic bile duct stones complicated with common bile duct stones[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(01): 81-86.

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URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2025016

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Figures/Tables 3

组别	例数	性别（例，男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	TB[μmol/L，M（Q₁，Q₃）]	ALT[U/L，M（Q₁，Q₃）]
腹腔镜组	12	3/9	57±9	21.2±2.2	17（97，327）	21（11，101）
传统组	15	8/7	60±19	21.2±1.8	197（167，53）	54（23，99）
统计值		-	t=-0.568	t=0.057	Z=-1.317	Z=-1.269
P值		0.137	0.518	0.956	0.188	0.205
组别	例数	AST[U/L，M（Q₁，Q₃）]	ALP[U/L，M（Q₁，Q₃）]	GGT[U/L，M（Q₁，Q₃）]	ALB（g/L， $\overset{ˉ}{x}$ ±s）	PT（s， $\overset{ˉ}{x}$ ±s）	肝功能分级（例，A/B）
腹腔镜组	12	26（22，54）	98（62，149）	71（21，229）	38±4	11.5±0.8	11/1
传统组	15	41（29，62）	67（47，112）	36（21，15）	37±3	11.7±1.0	12/3
统计值		Z=-1.196	Z=1.074	Z=0.195	t=0.524	t=-0.520	-
P值		0.232	0.283	0.845	0.605	0.608	0.605

组别	例数	性别（例，男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI（kg/m²， $\overset{ˉ}{x}$ ±s）	TB[μmol/L，M（Q₁，Q₃）]	ALT[U/L，M（Q₁，Q₃）]
腹腔镜组	12	3/9	57±9	21.2±2.2	17（97，327）	21（11，101）
传统组	15	8/7	60±19	21.2±1.8	197（167，53）	54（23，99）
统计值		-	t=-0.568	t=0.057	Z=-1.317	Z=-1.269
P值		0.137	0.518	0.956	0.188	0.205
组别	例数	AST[U/L，M（Q₁，Q₃）]	ALP[U/L，M（Q₁，Q₃）]	GGT[U/L，M（Q₁，Q₃）]	ALB（g/L， $\overset{ˉ}{x}$ ±s）	PT（s， $\overset{ˉ}{x}$ ±s）	肝功能分级（例，A/B）
腹腔镜组	12	26（22，54）	98（62，149）	71（21，229）	38±4	11.5±0.8	11/1
传统组	15	41（29，62）	67（47，112）	36（21，15）	37±3	11.7±1.0	12/3
统计值		Z=-1.196	Z=1.074	Z=0.195	t=0.524	t=-0.520	-
P值		0.232	0.283	0.845	0.605	0.608	0.605

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	出血量[ml，M（Q₁，Q₃）]	疼痛评分（分， $\overset{ˉ}{x}$ ±s）
腹腔镜组	12	276±41	300（225，600）	1.3±0.5
传统组	15	315±49	300（200，600）	2.2±0.4
统计值		t=-2.172	Z=0.349	t=-3.950
P值		0.040	0.727	＜0.001
组别	例数	手术并发症（例）			住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用（万元， $\overset{ˉ}{x}$ ±s）
组别	例数	胆漏	切口感染	肝衰竭	住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用（万元， $\overset{ˉ}{x}$ ±s）
腹腔镜组	12	2	1	0	13±3	7.7±1.1
传统组	15	3	7	1	19±7	9.5±2.7
统计值		-	-	-	t=-2.855	t=-2.301
P值		＞0.999	0.043	＞0.999	0.018	0.033

组别	例数	手术时间（min， $\overset{ˉ}{x}$ ±s）	出血量[ml，M（Q₁，Q₃）]	疼痛评分（分， $\overset{ˉ}{x}$ ±s）
腹腔镜组	12	276±41	300（225，600）	1.3±0.5
传统组	15	315±49	300（200，600）	2.2±0.4
统计值		t=-2.172	Z=0.349	t=-3.950
P值		0.040	0.727	＜0.001
组别	例数	手术并发症（例）			住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用（万元， $\overset{ˉ}{x}$ ±s）
组别	例数	胆漏	切口感染	肝衰竭	住院时间（d， $\overset{ˉ}{x}$ ±s）	住院费用（万元， $\overset{ˉ}{x}$ ±s）
腹腔镜组	12	2	1	0	13±3	7.7±1.1
传统组	15	3	7	1	19±7	9.5±2.7
统计值		-	-	-	t=-2.855	t=-2.301
P值		＞0.999	0.043	＞0.999	0.018	0.033

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