Abstract: Objective:To investigate the safety and shortterm effect of anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver.
Methods:The clinical data of 1 patient with hepatolithiasis combined with liver atrophyhypertrophy syndrome who was admitted to the Hunan Provincial People′s Hospital in April 2014 were retrospectively analyzed. The stones were located in the left and right liver, the involved liver became fibroatrophy, and the hepatic caudate lobe not containing stones became hypertrophy. The body surface area of the patient was 1.65 m2, standard total liver volume was 1 167.63 mL. According to the result of CT, expected residual liver volume after hepatectomy was 706.12 mL, and the ratio of residual liver volume over the standard total liver was 60.47%. The radio of residual liver volume over the body mass index was 1.21%. The patient received the second exploration of common bile ducts, hepatectomy with the caudate lobe as the sole remnant liver and T tube drainage. The followup including recurrence of calculus was performed by outpatient examination and telephone interview up to April 2015.
Results:The patient underwent caudate lobe as the sole remnant liver following anatomical hepatectomy successfully without blood transfusion. The operation time and volume of intraoperative blood loss were 380 minutes and 350 mL. The peritoneal drainage tube was removed at postoperative day 2 and the patient was discharged at postoperative day 8 with a good recovery of liver function. The postoperative pathological examination showed that there were focal biliary epithelial papillary hyperplasia combined with lightmedium atypical hyperplasia and no canceration. The T tube cholangiography two month later showed that there were unobstructed lower bile duct and no residual intra and extrahepatic stones. The liver function was normal. Then T tube was removed and patient resumed normal life. During the 1year followup, no chills and fever, jaundice and abdominal pain occurred, no calculus was detected by Bultrasonography, and computed tomography reexamination showed that remnant liver volume was increased and no intra and extrahepatic bile duct stones were detected.
Conclusion:Anatomical hepatectomy for the treatment of hepatolithiasis with the caudate lobe as the sole remnant liver is safe and feasible, with a good curative effect.