[Comparative study on the clinicopathological characteristics and prognosis of different types of hepatolithiasis]

Objective: To investigate the clinical and pathological characteristics, surgical approaches, and prognosis of patients with hepatobiliary calculi of different stone compositions. Methods: This is a retrospective cohort study. Data were collected from 353 consecutive cases of hepatobiliary calculi patients admitted to the Departments of Hepatobiliary Surgery of the two campuses of the First Affiliated Hospital of Army Medical University from January 2018 to December 2022. The patients included 130 males and 223 females, with an age of (52.7±13.0)years(range:18 to 80 years). According to stone composition, patients were divided into a primary cholesterol hepatolithiasis (PCHL) group (n=35), a primary biliary hepatolithiasis (PBHL) group (n=241), and a primary mixed hepatolithiasis (PMHL) group (n=77). General data, clinical manifestations, imaging features, and biochemical indicators were collected for all three groups. Comparisons among the groups were performed using one-way ANOVA, Kruskal-Wallis H test, or χ² test. For statistically significant data, post-hoc pairwise comparisons were conducted using Mann-Whitney U test, Fisher's exact probability method, or χ² test. Results: Pairwise comparisons between groups revealed that the incidence rates of abdominal pain, fever, and jaundice in the PCHL group were 8.6% (3/35), 5.7% (2/35), and 8.6% (3/35), respectively, all significantly lower than those in the PBHL group (80.9% (195/241), 32.0% (77/241), 30.3% (73/241)) and the PMHL group (76.6% (59/77), 27.3% (21/77), 24.7% (19/77)) (all P<0.017). In terms of imaging features, the proportions of hepatic atrophy and bile duct dilation in the PCHL group were both 2.9% (1/35), significantly lower than those in the PBHL group (39.8% (96/241), 91.3% (220/241)) and the PMHL group (26.0% (20/77), 64.9% (50/77)) (all P<0.017). Laboratory findings: the medians of glutamyl transferase, alkaline phosphatase, and total bilirubin in the PCHL group were 82 U/L, 105 U/L, and 12.9 μmol/L, respectively, all significantly lower than those in the other two groups (all P<0.017). The median serum albumin and mean cholesterol levels in the PCHL group were 42.9 g/L and 4.22 mmol/L, respectively, higher than those in the PBHL group (40.2 g/L, 3.74 mmol/L) (all P<0.017). Treatment approaches:in the PCHL group, 48.6% (17/35) underwent partial hepatectomy without biliary-enteric anastomosis, while the rates for hepatectomy with biliary-enteric anastomosis were 72.6% (175/241) and 43.2% (104/241) in the PBHL group, respectively. The corresponding rates in the PMHL group were 67.5% (52/77) and 36.4% (28/77), with statistically significant differences (all P<0.017). Conclusion: Intrahepatic PCHL exhibits significant differences from PBHL and PMHL in clinical symptoms,imaging features,biochemical parameters and therapeutic strategies, whereas PBHL and PMHL exhibit similar characteristics.