The clinical features and follow up results of 81 consecutive patients with intrahepatic stone (HIS) who underwent operation in Department of Surgery, Dong Kang Hospital, Ulsan during the period from May 1981 through March 1992 were presented.
The
median age presentation was 49 years(range, 23 to 76 years) and male to female ratio was 1 : 1.6. sixty nine cases985%) were followed for a median period of 1 year and 8 months(range, 3 months to 9 years) after operation. Over on e third of all
patients
had prior gall stone operation. The relative incidence of HIS among total 694 cases of gall stone disease operated during the same period was 11.7%. Common symptoms and signs were RUQ or epigastric pain(99%) and tenderness(91%), nausea &/ or
vomiting(63%), fever &/or chilling(59%).
Common laboratory findings were elevated serum GOT(80%), GPT(79%), alkaline phosphatase(59%), bilirubin(32%), and leukocytosis(67%). Detection rate of preoperative ultrasonography for HIS was 86%.
Location of HIS was left in 37 cases(46%), right in 12 cases(15%) (left to right ratio, 3 : 1), and both lobe in 32 cases(40%). Seventy two cases(89%) had concomitant extrahepatic duct stones. Sixty two cases undertaken aerobic bile culture of
which 41
cases(66%) showed positive bacterial culture. Multiple organisms were found in 24 cases(59%). Common bacterial organisms were E.coli(49%) and Klebsiells(39%). Partial hepatectomy was performed in 27 cases(33%), mainly in left side(left lateral
segmentectomy and hepatic lobectomy in 12 cases, respectively) except 3 cases of right hepatic lobectomy. Fifty four cases(67%) performed concomitant biliary bypass operation. Overall incidence of postoperative residual or recurrent stones was
58%
(47
cases) and it was not influenced by location of HIS(P>0.1), type of operation(hepatic resection or not, p>0.1), concomitant bypass operation or not, p>0.5), site of hepatic resection(p>0.5), hut it was higher in patients with bilateral HIS(88%)
compared
to unilateral HIS(32%) in hepatic resection group(P<0.02).
Postoperative complication rate was 53%, and it was higher in hepatic resection group(89%) compared to non-hepatic resection group(35%) (P<0.01). Operative mortality was 7%.
Among 69 cases followed up postoperatively, 38 cases(55%) were graded as "good., 12 cases(17%) as" fair., and 17 cases(25%) as" poor,, result. Relative incidence of good result was higher in hepatic resection group(75%) compared to non-hepatic
resection
group(44%)(P<0.02), but addition of biliary bypass procedure did not influence to follow up result.
In conclusion, aggressive hepatic resection rather than biliary bypass procedure alone should be performed if permitted in patients with HIS, especially of unilateral location.
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