Hepatic Resection for Intrahepatic Stones

ABSTRACT

The intrahepatic stones and associated cholangitis result in progressive biliary stricture, hepatic atrophy, hepatic abscess and ultimately in irreversible liver cirrhosis and biliary malignancy of the liver. Although removal of intrahepatic stones using stone fragmentation and cholangioscope has been a general treatment modality, hepatic resection with removal of the affected ducts should be required for a permanent cure. We experienced hepatic resection of 100cases with intrahepatic duct calculi from November 1978 to May 1996 in the Department of Surgery, Hanyang University Hospital. The results were as follows 1) The peak incidence of age was noted in the 4th decade (35 cases, 35.0%),5th decade (26 cases, 26.0%). 2) The male to female ratio was 46(46.0%)54(54.0%) in 100 cases. 3) Previous biliary operation(cholecystectomy with T-tube choledochostomy) was done in 30(30.0%) cases. 4) The most common clinical symptom and sign were RUQ pain(75 cases, 75.0%) and RUQ tenderness(75 cases, 75.0%). 5) In the lab findings, Alk P(55 cases, 55.0%) and ALT(52 cases, 52.0%) were especially increased. 6) 80 cases(80.0%) of intrahepatic stones were found in the left intrahepatic duct and 60 cases(60.0%) of Intrahepatic duct stones were associated cholelithiasis and/or choledocholithiasis. 7) 79 out of 100 cases had left lateral segmentectomy,15 out of 100 cases had left lobectomy, 3 cases had right lobectomy, 1 case pleurisegmentectomy, 1 case bisegmentectomy and 1 case atypical resection of the liver. 8) The incidence of residual stones was 10.0% and the incidence of recurrent cholangitis was 9.0%(9 cases). 9) The postoperative complications were wound complications(16 cases, 16.0%), chest complications(13 cases, 13.0%), bile leakage(4 cases, 4.0%), subhepatic abscess(3 cases, 3.0%). 10) The intrahepatic stones were combined with 3 cholangiocarcinoma,2 hepatocellular carcinoma and 1 GB cancer.