Surgical therapy for intrahepatic hepatolithiasis / 中华普通外科杂志

ABSTRACT

Objective To investigate the therapeutic effects of varied operative for the treatment of intrahepatic bile duct stones.Methods The clinical data of 176 consecutive cases of hepatolithiasis surgically treated in the past 3 years in our hospital were retrospectively analyzed.There were 45 type Ⅰ patients,25 type Ⅱ a patients,25 type Ⅱ b patients,3 type Ⅱ c patients,52 type Ea patients,19 type Eb patients,and 7 type Ec patients.These 176 patients were divided into 4 groups according to modus operandicholedocholithotomy and T-tube drainage in 71 patients (type Ea 31 patients,type Ⅰ 15 patients,type Ⅱ a 25 patients) ; choledocholithotomy and choledochojejunostomy in 25 patients (type Ea 14 patients,type Eb 7 patients,type Ec 4 patients) ; choledocholithotomy and hepaticojejunostomy in 10 patients (type Ⅱb 5 patients,type Ⅱ c 3 patients,type Ea 2 patients) ; hepatectomy plus T-tube drainage or choledochojejunostomy in 70 patients (type Ⅰ 30 patients,type Ⅱ b 20 patients,type Ea 5 patients,type Eb 12 patients,type Ec 3 patients).The postoperative residual stone rate,perioperative complications and long term results were compared between groups.Results Patients undergoing hepatectomy have less postoperative residual stone rate,higher rate of good long term efficacy as compared with those who did not undergo hepatectomy (17.1％ (12/70) vs 43.4％ (46/106),91.4％ (53/58) vs 77.0％ (67/87)).Though patients undergoing hepatectomy had higher rate of perioperative complications (37.1％ (26/70) vs 14.2％ (15/106)).Conclusions Hepatectomy is the most effective procedure for the treatment of type Ⅰ and type Ⅱ b hepatolithiasis.Hepaticojejunostomy is the main procedure for the treatment of type Ⅱ c hepatolithiasis.