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1、LiverHepato-Gastroenterology 2010; 57:1-6 H.G.E. Update Medical Publishing S.A., Athens-StuttgartSurgical Procedures for HepatolithiasisZheYu Chen, RiXiang Gong, YanLi Luo, LuNan Yan, TianFu Wen, NanSheng Cheng, Bing Hu, Shu, Gong, ZhaoDa Zhang, XuBao Liu, Weiming Hu, Bing Pen, Hong Wu, Bole Tian, G
2、ang Mai, Yong Zeng Department of Hepato-Bilio-Pancreatology Surgery, West China Hospital, Sichuan University, Chengdu 610041, China Corresponding Author: Yong Zeng E-mail:KEY WORDS: Liver transplanta- tion; Hepato- lithiasis; Surgical treatmentABBREVIATIONS: ?Background/Aims: The aim of this study i
3、s to explore the surgical treatment for hepatolithi- asis. Methodology: Data of 1431 consecutive patients who underwent surgical treatment from January 2000 to December 2006 in West China Hospital were collected retrospectively and analyzed. Sur- gical procedures included T-tube insertion com- bined
4、 intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojeju- nostomy and liver transplantation. Results: 1384 patients were performed T-tube insertion combined intraoperative and postop- erative cholangioscopic removal of intrahepatic stones and the rate of residual st
5、one was 11.5%. 370 patients were performed hepatectomy and the rate of residual stone was 2.7%. 23 patients were performed cholangiojejunostomy and the rate of residual stone was 26.1%. 15 patients of hepatolithiasis were performed liver transplanta- tion, and they had survived from liver transplan-
6、 tation. Conclusions: T-tube insertion combined intra- operative cholangioscopic removal of intrahepatic stones and cholangioscopic lithotripsy should be considered for patients of hepatolithiasis above all. Hepatic resection is optimal for patients with liver atrophy, liver abscess and biliary stri
7、cture. However, liver transplantation is a possible meth- od for end-stage hepatolithiasis.ABSTRACTINTRODUCTIONHEPATOLITHIASIS is a common disease in Southeast Asia, and the relative incidence of hepa- tolithiasis is 20% in China (1). Repeated acute epi- sodes of cholangitis are often seen in patien
8、ts with hepatolithiasis. As ultrasonography and computed tomography have come into wider use, it has be- come possible to not only identify the location of hepatic stones but also assess these stones qualita- tively. With magnetic resonance cholangiopancrea- tography (MRCP) or helical computed tomog
9、raphy (CT), the 3-dimensional structure of the bile duct can now be described; thus, the accuracy in diag- nosing hepatolithiasis has been greatly improved. Furthermore, with the improved radiological tech- niques and advanced endoscopy, successful treat- ment for clearing stones of hepatolithiasis
10、has been improved markedly (2, 3). However, residual stones of intrahepatic ducts inevitably occur. Now, surgical procedures for hepatolithiasis included choledocho- scopic removal of intrahepatic stones via a T-tube combined intraoperative cholangioscope, hepatec- tomy, cholangiojejunostomy, and li
11、ver transplanta- tion. To decrease residual and recurrence rates, it will be necessary to accurately diagnose the com- plex pathologic features of hepatolithiasis and se- lect the most effective treatment for each type of hepatolithiasis. In the present study, we clarify the indication of surgical t
12、reatments for hepatolithi- asis.METHODOLOGY From January 2000 to December 2006, 1431 patients with hepatolithiasis were admitted to De- partment of General Surgery, West China Hospi- tal, Sichuan University. All patients with a preop- erative diagnosis of cholangiocarcinoma associated with intrahepa
13、tic stones or only received non-surgi- cal procedures (laparotomy wasnt performed) were excluded from this analysis. Patients ranged in age from 18 to 86 years, with a mean age of 42 years. Based on the location of stones in the hepatic bile duct, patients were grouped into the following types: extr
14、ahepatic duct (E type), left lobe (L type), right lobe (R type), bilateral lobes (LR type), extrahepatic duct combined left lobe (EL type), extrahepatic duct combined right lobe(ER type), and extrahepatic duct combined bilateral lobes (ELR type). 1300 pa- tients of this study were ever found choleli
15、thiasis. 872 patients (61%) had previously undergone one time or more times biliary procedures. All patients underwent surgical procedures, and the presence of hepatolithiasis was confirmed. In terms of the treatment procedures, 1384 patients were performed T-tube insertion combined intraop- erative
16、 and postoperative cholangioscopic removal of intrahepatic stones, 370 patients were performed hepatectomy, 23 patients were performed cholan- giojejunostomy and 15 patients of hepatolithiasis were performed liver transplantation. Intraopera- tive cholangioscopy (external diameter, 4.9mm; CHF-P20; Olympus, Tokyo, Japan) was routinely Hepato-Gastroenterology 57 (00)ZY Chen, RX Gong, YL Luo, et al.used inst
