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KMID : 0870419970010020119
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1997 Volume.1 No. 2 p.119 ~ p.125
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LIVER RESECTION AND INTRAOPERATIVE CHOLANGIOSCOPIC EHL AS AN EFFECTIVE TREATMENT MODALITY FOR HEPATOLITHIASIS
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Han Se-Hwan
Lee Myeong-Soo
Kim Hong-Joo
Kim Young-Duck
Kim Hong-Yong
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Abstract
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Background: Hepatolithiasis is a prevalent disease in east Asian countries. However, there are still controversies about which treatment modality is most appropriate and effective.
Patients and Methods: Retrospective study was carried out on 66 patients surgically treated for intrahepatic duct(IHD) stone. Clinical profiles of patients were reviewed and modalities of surgical treatment were compared in respect to
outcomes and complications There were 40 females(60.6%) and 26 males(39.4%). The 5th and 6th decades exhibited peak incidence (54.5%).
Results: Stone location was mainly in the left lobe of the liver(51.5%), and bilobar distributiono occupied 27.3%(18 Gases). Partial liver resection was done in 42 cases(63.6%); left lateral segmentectomy in 30(71.4%), subsegmentectomy of right lobe in 8(19.1%), left lobectomy in 3(7.1%), right lobectomy in 1(2.4%). Hepaticojejunostomy with subcutaneous jejunostomy was carried out on 11 cases(16.7%) which had severe ductal stricturn and dilated common bile duct(CBD). Intraoperative cholangioscopic examination with electrohydraulic lithotripsy(EHL) was carried out on 44 cases (66.7%). Mean operation time was longer in the cases with EHL(199.3 min) than in the other group(156.2 min) However, the incidence of postoperative residual stone decreased with intraoperative cholangioscopic EHL without increase of
complications. Recurrent cholangitis was absent in the patients who received partial hepatectomy, and adequate biliary drainage procedure.
Conclusion: Resection of diseased part of the liver with adequate biliary drainage is the treatment of choice for hepatolithiasis. Intraoperative cholangioscopic examination with EHL can reduce the incidence of residual stone and provide precise information about biliary trees such as combined malignancy or ductal stricture.
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KEYWORD
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Electrohydraulic lithotripsy, Hepatolithiasis, Choledochoscope, Hepatectony, Electrohydrau1ic lithotripsy
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