Hepatectomy for hepatolithiasis

Objective To investigate the therapeutic effects of hepatectomy and different hepa-tectomized procedures for hepatolithiasis. Methods The clinical data of 498 consecutive cases of hepatolithiasis surgically treated during the past 14 years in our hospital were retrospectively analyzed. The postoperative residual stone rate, outcome and morbidity were compared between the patients received hepatectomy and those underwent non-hepatectomy. Results There were 63. 7% of the patients in this series underwent various types of hepatectomy. The percentage of patients undergoing hepatectomy during 2001-2004 (74. 6%) was significantly higher than that during 1991 - 1995 (49. 5%) and 1996-2000 (51. 1%). Meanwhile, the percentage of patients undergoing choledochojejunostomy and choledochostomy T tube drainage was decreased. The patients undergoing hepatectomy had less postoperative residual stone rate (19. 2% vs 31. 7%, P=0. 002), higher rate of good outcome (85. 2% vs 74.2%, P= 0.007) as compared with those receiving non-hepatectomy. However, there was no marked difference in the postoperative morbidity (wound complications were excluded) between the patients receiving hepatectomy and those undergoing non-hepatectomy. Eighty patients whose stones were localized at the left lateral lobe had no postoperative residual stone after left lateral segmentectomy. In those patients whose stones distributed beyond the left lateral lobe, the postoperative residual stone rate was 51. 2%, 14. 3%, 6. 25 and 11. 5% after the left lateral lobectomy, left hepatectomy, right hepatectomy and selective combined segmentectomy, respectively. The former was significantly higher than the latter three (P0. 001). The long-term outcome of left/right hepatectomy and selective combined segmentectomy was markedly better than the left lateral segmentectomy (P0. 001). Conclusions Hepatectomy is the most effective procedure for the treatment of hepatolithiasis. The long-term outcome of left/right hepatectomy and selective combined segmentectomy is better than that of left lateral segmentectomy in the patients whose stones distributing beyond the left lateral lobe.