The Clinical Study Of Surgical Treatment Of Intrahepatic Lithiasis

Objective: According to documents,the relative incidence of intrahepatic lithiasis has a trend to low down.From the analysis of different kinds of surgical methods to treat intrahepatic lithiasis and its Complications in an retrospect way, we try to evaluate the therapeutic value of different kinds of surgical methods.Method: Analysis of patients who suffered from intrahepatic lithiasis in a retrospect way.These patients accepted surgery in our hospital from January, 2002 to January, 2006. We investigate the distribution of lithiasis in liver, analyze the relationships between surgical methods and its complications, and so on.Result:1. Cholangitis in the history of this group of patients vary from 1 day to 56 years, 10.56±8.79 years in average; Bile duct explored histories range from 0 to 5 times; Hepatolithiasis distribution : (I,R)18 cases, (I,L)38 cases, (I,LR)19 cases, (IE)78 cases, (IE)10 cases.2. Different kinds of surgical methods: simple common bile duct explore+T-tube drainage 78 cases, left lateral lobe resection+ common bile duct explore+T-tube drainage 58 cases, left lateral lobe resection 7 cases,right posterior lobe resection+ common bile duct explore+T-tube drainage 4 cases, Other liver resection and / or common bile duct explore + T-tube drainage 10 cases, liver incision and/or common bile duct explore + T-tube drainage 6 cases.3. Liver function before operation in Child-Pugh graduation: A grade 145 cases, B grade 13 cases, C grade 5 cases.4. Complications: biliary residual stones 63 cases (38.65%) ; the sepsis 33 cases; wound infection 12 cases ; pulmonary infection 7 cases; abdominal infection 4 cases; biliary fistula 4 cases; pleural effusion 3 cases; biliary hemorrhage 1 cases; one cases of serious infection due to multiple organ failure and death (death rate 0.61%).5. The patients who undergo the resection of hepatic lesion have the incidence of 15.29% in postoperative residual stones; While, the patients who undo these have the rate of 64.10% in the postoperative residual stones. There are significant differences. Conclusion:1. The patients with hepatolithiasis who need surgical treatment is commonly around 50 to 60 years old. The patients who are less than 30 years old suffered from serious symptoms because of hepatolithiasis, of which we need a high degree of suspicion of congenital bile duct cyst which may associated with hepatolithiasis.2. Left hepatolithiasis and main intrahepatic stones is more common. Patients with main intrahepatic stones, is mainly in the left; As hepatolithiasis is benign lesion of a slow velocity in development stone obstructive, liver have full compensatory time ,so the majorities of patients have good liver functions.3. The patients who undergo the resection of hepatic lesion have lower residual stones rate than undo liver resection. There are significant differences.4. How to reduce the incidence of postoperative residual stones is also difficult; Infection control is an important impact on promoting the resumption of operations.