KẾT QUẢ LÂU DÀI CỦA PHẪU THUẬT CẮT GAN THEO GIẢI PHẪU VÀ THEO THƯƠNG TỔN CÓ KẾT HỢP NỘI SOI ĐƯỜNG MẬT TRONG MỔ ĐIỀU TRỊ SỎI TRONG GAN

Abstract

Background: Hepatolithiasis is common in East Asia. Hepatectomy is considered actually as the best method with high stone clearance and low stone recurrence rate.  Objectives: To evaluate the  long-term results and to propose the indications of this surgical method. Method: Noncontrolled longitudinal interventional study. Results: From 2/2011 to 2/2021, 134 hepatectomies were performed by laparoscopic (33 cases) and  open surgery (101 cases). The mean age was 47.14 (23 -77), 72,38% was female. Hepatolithiasis appeared in the left lobe 61,94%, right lobe: 13,43% and bilateral: 21,6%. 72,38% had bile duct strictures with 57,22%  on the left side, 11.19% on the right side  and 3,73% bilateral and 2.23% at the hilum. We realized 88 left hepatectomies, 15 right hepatectomies, 8 left lobectomies, 2 anterior sectionectomies, 3 posterior sectionectomies, 14 segmentectomies, and 4 bilateral hepatectomies. The immediate postoperative stone clearance rate was 82,83% (Retained stones occurred mostly in bilateral hepatolithiasis). The final stone clearance rate was 98%. The overall complications were 28.6% including: bile leakage 2.4%, liver failure 1.6% and 2 deaths. With a mean follow-up of 65,05 months, recurrent stones developed in 6,74% (6/89 patients) exclusively for bilateral hepatolithiasis. Conclusion: Anatomic liver and biliary lesion resection for intrahepatic stones is an effective treatment for hepatolithiasis, with a high stone clearance and a low stone recurrence rate. Indication of hepatectomy should be carefully considered for high recurrence risk regional hepatolithiasis or for intrahepatic stones associated with liver atrophy or bile-duct lesions.