Combined surgical therapy for hepatolithiasis.
OBJECTIVE
To evaluate the combined surgical therapy for calculi of intrahepatic duct.


METHODS
One hundred and eight cases of hepatolithiasis treated in our hospital from January 1986 to September 2003 were summarized and analyzed retrospectively. The primary surgery included 57 cases of biliary tract exploration and cholangiolithotomy, 26 cases of cholangiojejunostomy, and 25 cases of partial hepatectomy. Of these cases, 156 operations were performed totally. There were 36 patients undergoing two or more operations for cholangiolithiasis problem. Fiberoptic choledochoscopy was employed to examine and remove the residual stones during and after operation in all cases.


RESULTS
The residual stone rates were 57.89% (33/57), 26.92% (7/26), and 24.0% (6/25) for biliary tract exploration and cholangiolithotomy, cholangiojejunostomy, and partial hepatectomy, respectively. Fiberoptic choledochoscopy was utilized pre- and post-operatively for each patient, which was performed 2 to 9 times on each case. Following the combined treatment, the rate of residual stone after operation decreased to 12.96% (14/108).


CONCLUSIONS
The combined surgical therapy is valuable for resolving the problem of hepatolithiasis in most of the patients. Regarding the clinical outcomes of different surgical procedures, partial hepatectomy is superior to cholangiojejunostomy or biliary tract exploration and cholangiolithotomy. Fiberoptic choledochoscopy is also important to reduce the occurrence of residual stones and the rate of reoperation.
He
Xiao-dong
XD
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing. maoy@public3.bta.net.cn
Liu
Wei
W
Li
Bing-lu
BL
Zhang
Zheng-huan
ZH
Zhang
Jian-xi
JX
D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D020347:Lithiasis / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome