Laparoscopic Left Hemihepatectomy for Treatment of Left Intrahepatic Duct Stones

摘要

Intrahepatic duct (IHD) stone is a prevalent disease in southeast Asia. For complicated IHD stones, partial hepatectomy seems to be the most definitive management because it can remove all IHD stones and the stricture bile duct simultaneously, therefore reducing more risks for recurrent stones and development of cholangiocarcinoma. In 1991, Reich et al. reported the first case of laparoscopic liver resection. Since then, this procedure has been used for multiple hepatobiliary diseases. With the development of operative techniques and instrumentation, laparoscopic liver resection has become an effective method for the treatment of IHD stones. In this study, we described our experience with laparoscopic left hemihepatectomy for left IHD stones and determined its value and safety. In hemihepatectomy for the treatment of IHD, intraductal ultrasonography was used to reconfirm the contribution of IHD stones (Fig. 1A). The liver parenchyma on the surface of the left lateral lobe pedicle was cut off to expose the first porta. Then the left hepatic artery and left portal vein were ligated to achieve inflow occlusion (Fig. 1B-C). The parenchyma was continuously separated up to the portal, the left hepatic vein was clipped within the liver (Fig. 1D), and then the left lobe was removed. For patients associated with common bile duct stones, a cholelithoscope was used to remove stones in the common bile duct (Fig. 1E). Intraoperative cholan-giography was used to detect residual stones (Fig. 1F). A total of 32 patients underwent laparoscopic left hemihepatectomy. The mean operation time was 125.4 ± 76.3 minutes. Intraoperative bleeding volume was 150.7 ± 62.4 mL. The mean time for intestine function recovery after operation was 2.6 ±1.5 days and the mean duration of postoperative hospital stay was 4.1 ± 1.7 days. There were two cases of postoperative bile leakage (Table 1). Remnant stones were detected in two patients, and the success rate of stone clearance was 93.8 per cent. The remnant stones were removed by endoscopic sphincterotomy, and the final clearance rate was 100 per cent.