The therapeutic results have been poor in intrahepatic duct stones compared to gall bladder and extrahepatic duct stones because of difficulties in diagnosis and management, especially in cases combined with severe stricture and dilatation of
bile
ducts. We performed hepatic resection according to the location of the intrahepatic duct stones in 30 patients between October, 1987 and August, 1991.
By the location of intrahepatic duct stones, it was classified to the localized type when intrahepatic stones existed in one or two segment, and to the diffuse type in both lobes diffusely. The site inintrahepatic duct stones were identified
preoperatively by ultrasonogram, choledochoscopy and cholangiogram.
Sex ratio of male to female was 1 : 2 and most prevalent age group was in the 5th decade. The locations of stones in the localized type were left lobe 72%(21 patients), right lobe 6%(2 patients), right and left lobe 13%(4 patients). In the left
type,
the distribution of stones were S2.3 segment in 19 patients(63%), S3 segment in 1 patients(3%), and S2.3.4 segment in 1 patients(3%). In the right type, the distribution of stones was S6.7 segment in 2 patients(6%). In the both type, S2.3 segment
and
S5.6 segment in 1 patients(3%), and S6.7 segment in 3 patients (10%).
The diffuse type was in 3 patients(10%) and the site of intrahepatic duct stone was at the bifucation of the common hepatic duct in 2 patients. The operation methods in the localized type were as follows; left lateral segmentectomy(S2.3) in 20
patients(66%), left lobectomy(S2.3.4 in 1 patients(3%), right posterior segmentectomy(S6.7) in 2 patietns(6%), left lateral & right posterior segmentectomy(S2.3 & S6.7) in 3 patients(10%), and left lateral(S2.3) & S5.6 Segmentectomy in 1 patient
who had
both intrahepatic duct stone. In the diffuse type, the intrahepatic duct stones were removed as many as possible duct stone. In the diffuse type, the intrahepatic duct stones were removed as many as possible using operative choledochoscopy and
hepatico-jejumostomy were done in 2 patients, left lateral segmentectomy(S2.3) was in 1 patient.
Remained stones were 4 cases(13.0%), 2 cases of them were localized type and 2 cases of them were diffuse type. In 1 cases of localized type, remained stone was removed successfully by postoperative choledochoscopy. In 1 cases of diffuse type,
remained
stone was removed spontaneously.
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