关键词: 肝内胆管结石, 肝部分切除术, 胆肠吻合术, 结石残留, 结石复发, 影响因素

Abstract: Objective This study aimed to identify the major factors influencing postoperative residual or recurrent stones in patients with intrahepatic bile duct stones (IHBDS) after partial hepatectomy (PH) and biliary-enteric anastomosis (BEA). Methods 65 patients with IHBDS were encountered in our hospital between January 2022 and December 2024, and all underwent PH and BEA combination operation. Patients were followed-up for six months. Multivariate Logistic regression analysis was applied to reveal impacting factors for postoperative residual or recurrent stones. Results By end of six-month of follow-up, residual or recurrent stones were found in 14 cases(21.5%)by ultrasonography; age older, disease duration longer, percentages of right and left lobe stone distribution, biliary operation history and concomitant diabetes higher in patients with residual or recurrent stones than in without residual or recurrent stones(P<0.05); operative times, intraoperative blood loss, incidences of failed choledochoscopic stone removal and biliary stricture were (252.1±44.6)min, (502.9±162.7)ml, 42.9% and 50.0%, all much longer/greater/higher than [(210.8±33.9)min, (356.2±125.4)ml, 9.8% and 13.7%, respectively, P<0.05] in those without residual or recurrent stones; post-operationally, adverse events, such as bile leakage, cholangitis, delayed recovery of liver function tests and reoperation were 28.6%, 35.7%, 35.7% and 28.6%, all much higher than 3.9%, 11.8%, 17.6% and 5.9%(P<0.05), respectively, in those without residual or recurrent stones; multivariate Logistic regression analysis showed that disease duration longer than 5 yrs(OR=2.61, P=0.032), right and left lobe stones (OR=3.36, P=0.017), biliary operation history (OR=3.83, P=0.026), operational bleeding volume ≥400 mL(OR=3.16, P=0.037), biliary stricture (OR=4.34, P=0.014), postoperative bile leakage (OR=5.36,P=0.013) and postoperative cholangitis(OR=3.56, P=0.045) were all the independent impacting factors for residual or recurrent stones after surgery. Conclusion Surgeons should take impacting factors on stone residue or recurrence into consideration in clinical practice, and take measures to prevent and deal with it.

Key words: Intrahepatic bile duct stones, Partial hepatectomy, Biliary-enteric anastomosis, Stone residue, Stone recurrence, Impacting factors