Objective To assess the causes and methods of surgical treatment of hepatolithiasis reoperation Methods The clinical data of 81 cases of hepatolith reoperation were analyzed retrospectively. Results The main causes of hepatolith reoperation include biliary stricture,biliary tract variation,cholangiocarcinoma, etc. The chief reoperation patterns were hepatic lobectomy, Roux-en-Y hepaticojejunostomy, and lobectomy combined with Roux-en-Y hepaticojejunostomy.A follow-up of 2 months to 12 months showed excellent (outcome) of 93.8% of cases. According to postoperative cholangiograph,the retained stone rate was 6.2%. Conclusions When treating cholelithiasis ,we should follow the following principles: remove stones, relieve biliary stricture, correct biliary variation, resect abnormal liver, and establish adeguate biliary drainage.

Objective To evaluate different surgical repairments for iatrogenic bile duct injury Methods Clinical data of 145 patients with iatrogenic bile duct injury surgically treated in our department from Mar 1990 to Sep 2002 were retrospectively analyzed Results Bile duct end to end anastomosis、 or bile duct repair using the patient′s own tissues and medical glue, or Roux en Y bile duct jejunostomy were used in these 145 cases The average follow up time was 3 6 years (3 months to 11 years) in 130 cases The eutherapeutic rate was 94 6% Conclusion With good surgical expertise iatrogenic bile duct injury could be repaired by a variety of methods with a satisfactory results

Objective To study the preoperative diagnosis and treatment strategy of laparoscopic pancreatoduodenectomy (LPD) in patients with arterial anomalies.Methods The clinical data of 16 patients with arterial anomalies who underwent counterclockwise LPD at the Hunan People's Hospital from January 2016 to December 2017 were analyzed.Results The operation time was 370.0±109.0 min.The blood loss was 92.0±45.0 ml.In 14 patients,arterial anomalies were found preoperatively and were confirmed intraoperatively.The number of patients with a replaced right hepatic artery (rRHA),common hepatic artery (CHA) which originated from superior mesenteric artery (SMA),right hepatic artery (RHA) crossing in front of common bile duct (CBD),celiac artery (CA) and SMA with a common origin,right renal artery (RRA) anomaly were 5,3,3,2,and 1,respectively.In 2 patients,the anomalies were not found before operation:a dorsal pancreatic artery (DPA) originating from CHA,and a cystic artery and a right gastric artery (RGA) originating from left hepatic artery (LHA).Operative complications included biochemical fistula in 3 patients;peritoneal local effusion in 2 patients;pleural effusion in 2 patients;gastrointestinal anastomosis bleeding in 1 patient;delayed gastric emptying in 1 patient;a proper hepatic artery (PHA) pseudoaneurysm in 1 patient;and a subumbilical incision infection in 1 patient.The pathological results showed all the 16 patients had malignant tumors of the pancreas or ampulla.All the tumors were resected by R0 resection.Conclusion Arterial anomaly was common in LPD.Preoperative targeted radiological reading of X-rays,regional anatomical division combined with counterclockwise resection could result in early detection,identification and help to protect the arterial anomaly from injury and reduce the risk of serious postoperative complications.

Objective:To evaluate fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex.Methods:One hundred and sixty-seven cases undergoing hepatectomy guided by the boundary of liver fibrosis in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex from Jan 2011 to Dec 2019 in Hunan Province Peopole's Hospital were reviewed.Results:All patients were successfully treated by anatomical hepatectomy under the guidance of the liver fibrosis boundary with intraoperative choledochoscopy,the operation time was (231.5±37.1) min and the average blood loss was (375.7±52.6) ml,the average hospital stay was (10.2±1.1) days,the residual stone rate was 8.9%, according to the scoring system of Clavien-Dindo, Grade Ⅰ complications occured in 86 cases, Grade Ⅱ complications occured in 35.Follow-up ranged from 3 to 107 months, 15 cases had recurrent stones,four were reoperated.Conclusions:Fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex is safe and effective.

Objective To investigate the feasibility,safety and surgical technique of treating type Ⅲ and Ⅳ hilar cholangiocarcinoma by laparoscopy.Methods Clinical data and surgical process of 6 patients who underwent laparoscopic radical resection of hilar cholangiocarcinoma in the Hunan Provincial People's Hospital between April 2015 and October 2018 were retrospectively analyzed.The operations were performed by total laparoscopy in all the patients.Surgical procedure included the basic operation type (gallbladder,hilar and common bile duct resection,lymph node dissection of hepatoduodenal ligament),combined with the resectionof liver,caudate lobe,and portal vein resection and reconstruction.The follow-up time ranged from 1 to 42 months.Results The operation time was 540 ～ 660 min,the blood loss was 300 ～ 500 ml.One case of biliary leakage occurred after operation and healed within 2 weeks after drainage.The patients were all discharged succesfully and still alive.Conclusions Laparoscopic radical resection of type Ⅲ and Ⅳ hilar cholangiocarcinoma is safe and feasible under adequate preoperative evaluation,reasonable case selection and rigorous surgical planning.The short-term efficacy of the patients was good.

Objective To explore the treatment experience and efficacy of precise surgery for hepatic caudate lobe involved lesions.Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 127 patients with hepatic caudate lobe involved lesions who were admitted to Hunan Provincial People's Hospital between January 2012 and December 2016 were collected,including 71 of malignant tumors,52 of benign lesions and 4 of other diseases.Anatomical hepatectomy was performed in patients via left approach,right approach,anterior approach,left combined with right approach,left and right combined with anterior approach,left and right combined with para-liver hanging tape approach,anterior combined with left approach,retrograde approach according to their conditions.Observation indicators:(1) intraoperative and postoperative recovery situations;(2) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was done to detect postoperative survival of patients up to February 2018.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Kaplain-Meier method was used to calculate survival rate.Results (1) Intraoperative and postoperative recovery situations:all the 127 patients underwent successful operation without perioperative death,including 111 of open surgery and 16 of laparoscopic surgery.Of 127 patients,single total caudate lobectomy and partial caudate lobectomy were performed in 2 and 13 patients,single hepatic segmentectomy combined with total caudate lobectomy,double hepatic segmentectomy combined with total caudate lobectomy,hepatic trisegmentectomy combined with total caudate lobectomy,left hemitectomy combined with total caudate lobectomy,left hepatic trilobectomy combined with total caudate lobectomy,right hemitectomy combined with total caudate lobectomy,right hepatic trilobectomy combined with total caudate lobectomy were performed in 6,4,5,1,1,30,3 patients respectively,single hepatic segmentectomy combined with partial caudate lobectomy,double hepatic segmentectomy combined with partial caudate lobectomy,left hemitectomy combined with partial caudate lobectomy,left hepatic trilobectomy combined with partial caudate lobectomy,right hemitectomy combined with partial caudate lobectomy,right hepatic trilobectomy combined with partial caudate lobectomy were performed in 3,3,41,2,5,8 patients respectively,including 78 via left approach,29 via right approach,2 via anterior approach,7 via left combined with right approach,2 via left and right combined with anterior approach,6 via left and right combined with para-liver hanging tape approach,1 via anterior combined with left approach,2 via retrograde approach.The operation time,time of first hepatic hilum occlusion,volume of intraoperative blood loss and duration of postoperative hospital stay were 285 minutes (range,188-670 minutes),47 minutes(range,30-150 minutes),294 mL(range,20-2 500 mL) and 10 days (range,6-27 days) respectively.Thirty-four patients had postoperative complications,including 21 with abdominal ascites,20 with pleural effusion,6 with incisional infection,5 with hemorrhage,4 with bile leakage,2 with pulmonary infection (1 patient combined with multiple complications).One patient underwent reoperation after ineffective conservative treatment for hemorrhage within postoperative 24 hours and other 33 were cured by conservative treatment.(2) Follow-up and survival situations:of 127 patients,124 including 68 of malignant tumors and 56 of non-malignant tumors were followed up for 2-71 months with a median time of 33 months.During the follow-up,1-,3-,5-year overall survival rates were 83.1％,63.4％,22.5％ in 68 patients with malignant tumors,89.3％,71.4％,57.1％ in 28 patients with hilar cholangiocarcinoma and 76.9％,46.2％,23.1％ in 26 with hepatocellular carcinoma.All the 56 patients with non-malignant tumors survived well.Conclusions Anatomical hepatectomy using precise surgery is safe and feasible.Preoperative precise evaluation and surgical procedure design,intraoperative vascular control and surgical plane mastering are keys to success.