Treatment of left intrahepatic bile duct stones by left hemihepatectomy reserving lobus caudatus

Abstract

Objectives To analyze risk factors and therapeutic method of postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones.Methods The clinical data of 263 cases of surgery by resection of the left hepatic lobe for the left intrahepatic bile duct stones were analyzed retrospectively between April 1998 and August 2008.All influential factors were checked in chi square,and independent risk factors about postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones were analyzed.Simultaneously,times of postoperative choledochoscope were compared with chi square,about cases of left hemihepatectomy reserving lobus caudatus with high risk factors between September 2008 and June 2003 and resection of the lefi hepatic lobe for the left intrahepatic bile duct stones.Results Univariable analysis showed postoperative stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones were associated with liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture,bile duct stones in segment Ⅳ,and liver fibrosis of segment Ⅳ (P =0.000).The surgery of left hemihepatectomy reserving lobus caudatus reduced times of postoperative choledochoscope significantly(P =0.000) campared with resection of the left hepatic lobe.liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture and bile duct stones in segment Ⅳ were independent risk factors of stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones,which was showed by multivariate unconditional Logistic regression analysis (P ＜ 0.05).Conclusions Liver atrophy of segment Ⅳ,the opening of the left hepatic duct stricture and bile duct stones in segment Ⅳ were independent risk factors of stones recurrence by resection of the left hepatic lobe for the left intrahepatic bile duct stones.And Surgery by left hemihepatectomy reserving lobus caudatus was effective therapeutic method to the left intrahepatic bile duct stones with high risk factors. Key words: Hepatectomy; Cholelithiasis ; Therapeutic uses