title: Preliminary study of a new pathological evolution-based clinical hepatolithiasis classification.
abstract: OBJECTIVE
  To investigate clinical features, treatment strategies and outcomes of patients with hepatolithiasis (HL) undergoing surgical treatment, using a new clinical classification.
  
  
  METHODS
  Sixty-eight HL patients were hospitalized and treated surgically from August 2011 to December 2012 and they were classified into four HL types according to pathological evolution of the disease. These four HL types included type I primary type (defined as no previous biliary tract surgery), type II inflammatory type (with previous biliary tract surgery and cholangitis), type III mass-forming type (HL complicated by hepatic mass-forming lesion), and type IV terminal type (with secondary biliary cirrhosis and resultant portal hypertension). The perioperative data including general information, imaging data, postoperative complications, and immediate and final stone clearance rate were obtained and analyzed.
  
  
  RESULTS
  In all 68 patients, the proportion of HL type I-IV was 50% (34/68), 36.8% (25/68), 10.3% (7/68) and 2.8% (2/68), respectively. Abdominal pain was the main clinical manifestation in type I (88.2%), fever was predominant in type II (52.0%), the malignancy rate in type III was high (71.4%), and portal hypertension and spleen enlargement were common in type IV (2/2, 100.0%). Liver resection rate for types I-III was 79.4%, 72.0% and 71.4%, respectively. The overall incidence of postoperative complications was 23.5% (16/68). There were no perioperative deaths. The average length of hospital stay was 12.7±7.3 d. Immediate and final stone clearance rate was 73.5% (50/68) and 89.7% (61/68), respectively. Fifty-nine of 68 patients (86.8%) were followed- up for >1 year after surgery, and 96.6% of these patients (57/59) had a good quality of life according to a criterion recommended for postoperative evaluation of quality of life.
  
  
  CONCLUSIONS
  The pathological evolution-based clinical classification of HL has a role in optimizing treatment strategy, and patients can benefit from this classification when it is used properly.
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Fu-Bao
authors.initials: FB
authors.lastname: Liu
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Yu
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Guo-Bing
authors.initials: GB
authors.lastname: Wang
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Yi-Jun
authors.initials: YJ
authors.lastname: Zhao
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Kun
authors.initials: K
authors.lastname: Xie
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Fan
authors.initials: F
authors.lastname: Huang
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Jiang-Ming
authors.initials: JM
authors.lastname: Cheng
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Xin-Rao
authors.initials: XR
authors.lastname: Wu
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Chao-Jie
authors.initials: CJ
authors.lastname: Liang
authors.affiliation: Fu-Bao Liu, Xiao-Jun Yu, Guo-Bing Wang, Yi-Jun Zhao, Kun Xie, Fan Huang, Jiang-Ming Cheng, Xin-Rao Wu, Chao-Jie Liang, Xiao-Ping Geng, Department of Hepato-Pancreato-Biliary Surgery, the First Affiliated Hospital, Anhui Medical University, Hefei 230000, Anhui Province, China.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Geng
mesh_terms: D000328:Adult; D003661:Decision Support Techniques; D003952:Diagnostic Imaging / Q000379:methods; D016145:Endoscopy, Digestive System / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000473:pathology; D007902:Length of Stay; D020347:Lithiasis / Q000145:classification / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008099:Liver / Q000473:pathology* / Q000601:surgery*; D008105:Liver Cirrhosis, Biliary / Q000209:etiology / Q000473:pathology; D008107:Liver Diseases / Q000145:classification / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Clinical pathology; Disease classification; Hepatolithiasis; Liver diseases; Surgery