Wu Dihang, Huang Long, Liao Chengyu, Li Ge, Pan Junyong, Wang Liang, Chen Zhiyun, Lin Ye, Zhang Chun, Wang Congren, Chen Yufeng, Lin Tiansheng, Lai Jianlin, Chen Yanling, Tian Yifeng, Chen Shi
Shengli Clinical Medical College of Fujian Medical University Fuzhou, Fuzhou, China.
Department of Hepatobiliary Pancreatic Surgery, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, China.
Surg Endosc. 2025 May;39(5):2855-2873. doi: 10.1007/s00464-025-11651-2. Epub 2025 Mar 14.
Hepatectomy is the primary treatment for regional hepatolithiasis, but recurrence rates range from 10 to 20%, often necessitating repeat surgery. Although laparoscopic hepatectomy has been widely adopted for recurrent hepatocellular carcinoma, its use in recurrent hepatolithiasis remains limited due to technical challenges, including severe adhesions, anatomical distortions, and increased risks of complications. No large-scale study has compared laparoscopic and open repeat hepatectomy for recurrent regional hepatolithiasis.
This multicenter retrospective study included 913 patients from nine high-volume centers in southeastern China between May 2014 and 2023. Patients were divided into laparoscopic (n = 338) and open surgery (n = 575) groups. Propensity score matching was used to balance baseline characteristics. Primary outcomes included stone clearance rates and textbook outcomes (TO), a composite measure assessing final stone clearance, hospital stay, bile leakage, major complications, and 30-day readmissions. Secondary outcomes included perioperative metrics, complication rates, and recurrence-free survival.
After PSM, laparoscopic surgery demonstrated comparable immediate stone clearance rates (81.07% vs. 78.40%, p = 0.386) but significantly better TO rates (61.54% vs. 46.09%, p < 0.001) to the open surgery group. The laparoscopic group had reduced blood loss (p = 0.016), shorter hospital stays (p < 0.001), faster recovery of bowel function (p < 0.001), and fewer major complications (13.91% vs. 23.08%, p = 0.003). Recurrence rates were similar between groups during a median follow-up of 36 months. Hepatic lobe atrophy and biliary strictures were identified as independent risk factors for reduced stone clearance.
Laparoscopic repeat hepatectomy offers comparable stone clearance rates to open surgery while providing significant advantages in perioperative outcomes, including reduced complications and faster recovery. These findings suggest laparoscopic surgery is a feasible and effective option for recurrent regional hepatolithiasis.
肝切除术是治疗区域性肝内胆管结石的主要方法，但复发率在10%至20%之间，常常需要再次手术。尽管腹腔镜肝切除术已被广泛应用于复发性肝细胞癌，但由于技术挑战，包括严重粘连、解剖结构扭曲以及并发症风险增加，其在复发性肝内胆管结石中的应用仍然有限。尚无大规模研究比较腹腔镜与开放再次肝切除术治疗复发性区域性肝内胆管结石的效果。
这项多中心回顾性研究纳入了2014年5月至2023年期间来自中国东南部9个高容量中心的913例患者。患者被分为腹腔镜手术组（n = 338）和开放手术组（n = 575）。采用倾向评分匹配法平衡基线特征。主要结局包括结石清除率和教科书式结局（TO），这是一种综合指标，用于评估最终结石清除情况、住院时间、胆漏、主要并发症和30天再入院率。次要结局包括围手术期指标、并发症发生率和无复发生存率。
倾向评分匹配后，腹腔镜手术的即时结石清除率与开放手术组相当（81.07%对78.40%，p = 0.386），但TO率显著更高（61.54%对46.09%，p < 0.001）。腹腔镜组术中失血更少（p = 0.016），住院时间更短（p < 0.001），肠功能恢复更快（p < 0.001），主要并发症更少（13.91%对23.08%，p = 0.003）。在中位随访36个月期间，两组的复发率相似。肝叶萎缩和胆管狭窄被确定为结石清除率降低的独立危险因素。
腹腔镜再次肝切除术的结石清除率与开放手术相当，同时在围手术期结局方面具有显著优势，包括并发症减少和恢复更快。这些发现表明，腹腔镜手术是复发性区域性肝内胆管结石的一种可行且有效的选择。
