The surgical management of intrahepatic stones is problematic because it is difficult to locate and remove all the stones and relieve the accompanying biliary strictures. Consequently, the rate of recurrent cholangitis is high.
In the pase 5 years we adopted a systemic approach comprised of accurate delineation of disease in the liver and biliary tract by direct cholangiography, ultrasonography, and computed tomography; tailored surgical treatment according to the
extent
of
involvement of the liver and biliary tract(NMC classification of IHD stone, 1986); access to the intrahepatic ducts through the left duct or round ligament approach when there was difficulty with common bile duct exposure; routine use of flexible
choledochoscopy.
The results of surgical treatment in 72 patients with intrahepatic stones are reported according to 5 types of IHD stone(NMC classification).
Type I and II are extrahepatic predominent type. Type III is only left lobe type, and type IV s only right lobe type and type V is both type.
Type III and V are more common type(47.2% and 27.75) and fortunately type IV is low in incidence(8.3%).
In type III with severely damaged damaged liver segment, partial hepatic resection is good procedure with high improvement rate and low residual stone(93.7% and 31%). But in type V, hepaticocutaneous jejunostomy is available for postoperatively
stone
removal and management of postoperative cholangitis.
In conclusion, complete removal of intrahepatic stones, stricture and damaged hepatic segment shows good surgical results.
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