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KMID : 0870420080120010034
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2008 Volume.12 No. 1 p.34 ~ p.40
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The Surgical Treatments for the Hepatolithiasis
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Choi Sae-Byeol
Kim Kyung-Sik
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Abstract
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Hepatolithiasis is characterized by its intractable nature and frequent recurrences that require multiple operative interventions. Intrahepatic stones consist of calcium bilirubinate in most cases, but these stones contain more cholesterol than the stones in the common bile duct. The pathogenesis of primary bile duct stones is based upon bile stasis and infection. Bile duct stricture and dilatation of the duct are usually present in cases with brown pigmented stones. In
addition to cholangitis, liver abscess and longstanding sepsis, intrahepatic stones and strictures can cause secondary biliary cirrhosis and intrahepatic cholangiocarcinomas. Pyogenic cholangitis that’s due to strictures and hepatolithiasis tends to recur; therefore, operations such as stricturoplasty, hepaticojejunostomy and liver resection are inevitable. The primary goals of surgery are to eliminate stones and the atrophic liver tissue, and to correct the bile stasis. Recent
advances have been made in noninvasive treatments, such as percutaneous transhepatic cholangioscopic lithotripsy (PTCSL). Because postoperative residual stones and recurrent stones occur frequently, PTCSL and dilatation therapy will improve the outcomes of patients suffering with hepatolithiasis combined with bile duct stricture.
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KEYWORD
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hepatolithiasis, cholangitis, cholangiocellular carcinoma, hepatic resection, hepaticojejunostomy
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