Surgical Experience for Intrahepatic duct Stones / 한국간담췌외과학회지

ABSTRACT

BACKGROUND: The stones in the biliary tree situated proximal to the origin of the common hepatic duct are considered intrahepatic duct stone. This conditon causes the serious problems including cholangitis, obstructive jaundice and liver abscess. AIM AND METHOD: This study is a clinical review for the results of surgical treatment in 178 cases of patients with intrahepatic stones in the Department of Surgery, Gyeongsang National University Hospital from January 1991 to December 1997. RESULTS: Sex ratio of male to female was 1 2.1 and most prevalent age group was 6th decade. Common symptom and sign was RUQ pain(83.2%) and tenderness(64.7%). Common laboratory finding were elevated alkaline phosphatase(56.6%), elevated serum GOT(47.4%), leukocytosis (44.5%) and hyperbilirubinemia(36.4%). C. Sinensis was identified in 22 cases(12.4%) of operation cases. Intrahepatic stones were located in the left hepatic duct in 87 cases(48.9%), the right duct in 27 cases(15.2%) and both intrahepatic duct in 64 cases (35.9%). Partial hepatectomy was performed in 94 cases(52.8%), non-hepatectomy was performed in 84 cases(47.2%). The remained stone was noted in 57 cases(32%) of operation cases. Among them, 39 cases(68%) were non-hepatic group, 18 cases(32%) were hepatic group. Postoperative complication rate in hepatic resection group(29.8%) was higher than that in non-resection group(15.5%). Most common complication was wound infection and operative mortality was 2.2%. The follow-up study showed that 146 cases(82%) were graded as good, 7 cases(3.9%) as fair and 25 cases(14%) as poor result and relative incidence of good result in hepatic resection group(88.3%) was higher than that in non-hepatic group(75%). CONCLUSIONS: We conclude that hepatic resection rather than biliary bypass procedure alone as an initial treatment for hepatolithiasis is satisfactory treatment.