Background and Aims: For patients with recurrent hepatobiliary stones after a repeated operation, how to safely and completely remove the stones, maximally relieve the stenosis in the hilar and even intrahepatic bile ducts, and then construct or repair a patent passage for bile flow has always been a difficult problem in the therapeutic field of biliary surgery. This study was undertaken to determine the clinical efficacy and application value of resection of the quadrate lobe of the liver combined with high-level splitting and plasty of the hilar bile ducts in treatment of hilar bile duct stenosis complicated with hepatolithiasis. 
Methods: The clinical data of 36 patients with complicated hepatobiliary stones treated in Hunan Provincial People's Hospital from July 2015 to June 2019 were retrospectively analyzed. All the 36 patients had a different degree of hilar bile duct stricture, with an average number of previous operations of 2.4. Of them, the stricture located only at the hilar bile duct confluence in 18 cases, and with combined stricture at the right hepatic duct in 8 cases or left hepatic duct in 10 cases.
Results: All patients underwent hepatic quadrate lobe resection, hilar bile duct splitting and plasty, and bilioenteric drainage, and the stones were thoroughly removed during operation by means of lithotomy forceps, tube flushing and choledochoscopic exploration. The average operative time was 354.4 min, and the average intraoperative blood loss was 230.5 mL, and the final stone clearance rate exceeded 90%. After operation, bile leakage occurred in 2 patients, which was improved after aggressive drainage treatment, fat liquefaction and infection of incision occurred in 3 patients and partial intestinal obstruction occurred in 1 patient, which were all improved after conservative treatment. During the 12-48 months of follow-up by telephone and clinic visits, 4 patients developed reflux cholangitis and none of them had recurrent stricture of bilioenteric anastomosis.
Conclusion: Quadrate lobectomy combined with high-level splitting and plasty of the hilar bile ducts can effectively relieve the high-level stricture of the hilar bile ducts and achieve the goal of thorough stone removal and patent bile drainage. Meanwhile, it can avoid extensive liver resection. So, it has certain application value in clinical practice.