ĐÁNH GIÁ KẾT QUẢ PHẪU THUẬT CẮT GAN ĐIỀU TRỊ SỎI TRONG GAN VÀ CÁC BIẾN CHỨNG CỦA SỎI TRONG GAN CÓ SỬ DỤNG NỘI SOI ĐƯỜNG MẬT BẰNG ỐNG MỀM

Abstract

- Study aim: 1. Evaluation of clinic feature and para clinnic feature of hepatolithiasis and its complications as hepatic ductal stricrure, liver absceses and hemobilia, recurrent cholangititis... 2. Indications and result of hepatic resection in surgical treatment of hepatolithiasis  using flexible choledochoscopy in detection of additional stones and bile duct lesions related to repeated cholangititis segment,liver absceses and hemobilia, stenotic duct... - Patient and method: Prospective study. Time: 2007-2011. – Result: + There were 31 patients, female 24 patients (77,4%), male 7 patients (22,6%), 90,3% were famer, the mean age was 44,5± 12,7 years (range 18-73 years), 45,2% had  a  history of biliary surgery. Clinic symptoms: Recurrent abdominal pain, fever, jaundice in  45,1%, recurrent abdominal pain and jaundice in 25,8%,abdominal pain only in 25,8%, fever and abdominal pain in 3,3%. Elevation of leucocyte > 10.000/mm3 in 45,2%, elevation of VSS in 100%. Elevation of bilirubilemie in 45,2%.  Abdominal Ultrasound revealed  intra hepatic stones or intrahepatic and common bile duct stones in 100%. Hepatic resection indications  for stenotic hepatic duct in 74,2%, related to cholangitic absceses in 45,1%, related to  hemobilia in 4 patients (12,9%). Operation performed: Left lateral segmentectomy in 22 patients (71%), medial  segmentectomy in 1 patient, left hepatic lobectomy in 1 patient, left hepatic lobectomy extended to anterior segment in 1 patient, subsegmentectomy in 6 patients (19,3%) (3 subsegment III,3 subsegmentVIII). + Post operative cholangiography confirmed no residual stones in 77,42%, Residual stones in 7 patients (22,58%) among them: retained stones of segmental hepatic duct  in 2  patients, (1 right anterior segment, 1right posterior segment), retained stones of subsegmental duct in 5 patients. There was no death per and post operation. Complications: There were 4 patients (12,9%): subphrenic collection in 2 patients (biliary fistula), intraabdominal bleeding in 1 patient, intertinal occlusion in 1 patient. – Conclusion: We concluded that hepatic resection combined with routine use of intraoperative flexible choledochoscopy for detection of packed stones behind stenotic duct, liver absceesses, hemobilia is a satisfactory  surgical method  to   reduce  retained intrahepatic stones and to eradicate the hepatic  segment  related to repeated infection, biliary stricture, liver abscesses, hemobilia... + The proportion of stones clearance was 77,42%, + The proportion of retained stones was 22,58%. There were no retained stones in commont bile duct and commont hepatic duct.