Wang Wei, Yang Chuanxin, Wang Jie, Chen Wei, Wang Jian
Department of Hepatobiliary and Pancreatic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 600 Yishan Road, Shanghai, 200233, China.
Department of Biliary-Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
J Gastrointest Surg. 2023 May;27(5):914-925. doi: 10.1007/s11605-022-05572-x. Epub 2023 Jan 17.
This study aims to propose a novel classification system to standardize the treatment of hepatolithiasis.
A hepatolithiasis classification named LHO was proposed to represent the distribution of stones in the segmental bile ducts and the hepatic atrophy associated with the stones (L), the existence of stones or strictures in the hilar bile duct (H), and dysfunction of the Oddi sphincter (O), which can be used to formulate ideal surgical protocols. One hundred and forty-seven primary hepatolithiasis patients treated between 2013 and 2018 were classified into different types and divided into two groups. If the patient's actual surgical procedure matched the ideal surgical protocol, the patients were included in the matching group; otherwise, patients were included in the nonmatching group. The rates of residual stones, recurrence, and a good quality of life (QOL) were analyzed among the patients in the matching and nonmatching groups and previous reports.
According to the classification of each patient, 77.6% of the patients were included in the matching group, and 22.4% were included in the nonmatching group. The rates of residual stones, recurrence, and a good QOL were significantly better in the matching group than in the nonmatching group (9.6% vs. 27.3%; 8.0% vs. 35.0%; 89.5% vs. 65.4%); the rates of residual stones and a good QOL were also better than those in previous reports (9.6% vs. 19.1%; 89.5% vs. 61.6%).
The LHO classification can comprehensively reflect the key points of treatment, which is beneficial for formulating effective and standardized surgical plans of hepatolithiasis.
本研究旨在提出一种新的分类系统，以规范肝内胆管结石的治疗。
提出一种名为LHO的肝内胆管结石分类方法，该方法可表示结石在肝段胆管中的分布以及与结石相关的肝萎缩（L）、肝门胆管结石或狭窄的存在情况（H）以及Oddi括约肌功能障碍（O），可用于制定理想的手术方案。将2013年至2018年期间接受治疗的147例原发性肝内胆管结石患者分为不同类型，并分为两组。如果患者的实际手术操作与理想手术方案相符，则将患者纳入匹配组；否则，将患者纳入不匹配组。分析匹配组和不匹配组患者以及既往报道中残余结石、复发和良好生活质量（QOL）的发生率。
根据每位患者的分类，77.6%的患者被纳入匹配组，22.4%的患者被纳入不匹配组。匹配组的残余结石、复发和良好生活质量发生率显著优于不匹配组（9.6%对27.3%；8.0%对35.0%；89.5%对65.4%）；残余结石和良好生活质量发生率也优于既往报道（9.6%对19.1%；89.5%对61.6%）。
LHO分类可全面反映治疗要点，有利于制定有效的、标准化的肝内胆管结石手术方案。
