Clinical Review and Surgical Treatment of Intrahepatic Stones / 한국간담췌외과학회지

ABSTRACT

BACKGROUND: Intrahepatic stones are common in East Asia and pose serious complications such as biliary stricture, liver atrophy, liver abscess, sepsis and sometimes cholangiocarcinoma. The management of primary intrahepatic stones is difficult and it is also difficult to remove all stones during operation. METHODS: Eighty seven patients with hepatolithiasis were admitted to the department of surgery, Keimyung University Dongsan Medical Center during 4 year period between 1994 and 1997. We reviewed medical records retrospectively for these patients. RESULTS: The peak incidence of age was 50's and the male to female ratio was 11.2. Intrahepatic stones were located in the left lobe in 62.1%, right lobe 17.2% and both lobe 20.7%. Stones were found only within the liver (I type) in 34.5% and both inside and outside the liver (IE type) in 65.5%. Analysis of the composition of intrahepatic stones revealed calcium bilirubinate as the most common compound (over 75%) and E. coli was the most common organism in bile culture. We classified intrahepatic stones as four types. Type I (45.9%) is cases with liver atrophy on abdominal CT, type II (20.6%) is cases without liver atrophy as IE type, type III (16.0%) is cases with dilatation of extrahepatic bile duct as I type, and type IV (17.2%) is cases without liver atrophy nor extrahepatic bile duct dilatation. Of the 72 operated patients, liver resection was done in 43 (59.7%) and 9 patients (20.0%) had residual stones. Cholangiocarcinoma was found in 3 (7.0%) of the total 43 patients who underwent liver resection. CONCLUSION: Hepatic resection should be performed in selected patients with intrahepatic stones because of lowest presence of residual stones and no difference of postoprative complications compared with drainage procedure.