The surgical management of intrahepatic stones is problematic because of difficulty not only in finding and removing of all stones, but in relieving of accompanying biliary strictures.
This study was performed to evalute the prognostic significance of various operation methods, especially that of the stone basket removal.
From jan. 1987 through Dec. 1991, 68 cases with intrahepatic stones had underwent operation were reviewed. Percutaneous stone removal procedure was done in 26 cases. The results were as follows: Of all 244 choledochotomy cases, the incidence of
intrahepatic stones was 27.8%, it was most frequent occured 4th to 7th decade and female was more commonly affected by the ratio 1:1.8. The accuracies of each diagnostic methods were 71%(USG), 80%(T), 82.3%(ERCP), and 100%(PTC/PTBD). L-type was
most
common (57.3%) and LR type(23.5%), R type (19.2%) were followed in decreasing order of frequency. I, IE, IE and IE type were occupied in 75%, 14.7%, 7.3%, 3.0% respectively. Operation methods used were performed by the one of the followings;
drainage
procedures (with or without hepatic resection), choledochotomy and T-tube drainage (with or without hepatic resection). We preferred the methods of choledochotomy and T-tube drainage without hepatic resection. Overall operative mortality rate was
4.4%;
three were died of sepsis, cardiac arrythmia, and lung cancer, respectively. Since 1990, percutaneous extractions of residual biliary tract stones through T-tube tract were performed in 26 cases. Success rate was 88.5%. The prognosis was more
favorable
in 1990-91 operation group (good and fait 76.1%, poor 12%) than in 1987-80 operation groups (good and fiar 62.2%, poor 6.7%) Conclusively, the above results proved the effect of percutaneous extraction of residual biliary tract stones.
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