Clinical Analysis Of 152 Case Diagnosed With Intrahepatolithias On Diagnosis And Surgery Treatment

Objective: Review of Diagnosis and Surgery Treatment of intrahepatolithias in past decadeMethod: Retrospective analysis and study on 152 patients with intrahepatolithias operation in our hospital from January 1998 to December 2008.Result: 1 Therapy Methods: 99 cases with Ultrasonic,which covers 65%. 97 cases with CT, 63%. 13 Cases with MRCP, 8%.3 Cases with ERCP,2%. 1 case with intraoperative choledochoscopy, 0.66%. 1.1 Between 1998 and 2004, in a sample with 38 patients, 21 cases were diagnosed with Ultrasonic, meanwhile, 15 cases with CT, 1 case with MRCP, 1 with ERCP. Comparatively speaking, between 2004 and 2008, in a sample with 114 patients, 78 cases were diagnosed with Ultrasonic, 72 with CT, 12 with MRCP. 2 with ERCP, 1 case with intraoperative choledochoscopy2 of the 152 patients in our hospital, 11 patients had intrahepatolithias after cholecystectomy while 16 patients had calculi after biliary exploration. 15 patients,5 of whom with complications, underwent lobectomy of liver, which covers 9.78%. 96 patients underwent Open biliary exploration, covering 63.16%, of whom 26 cases had complications. 27 patients underwent Laparoscopy biliary exploration calculi-taken, covering 17.76%, of whom 2 cases had complications. 9 cases with ERCP, 5.92%,1 of whom with complications,3 cases with percutaneous hepatic puncture, covering 1.32%,no complication occurs.3. Between 1998 and 2004, 24 patients underwent open biliary exploration, 3 cases with lobectomy of liver, 2 cases with ERCP. On the other hand,between 2004 and 2008, there were 72 patients with open biliary exploration, 27 cases with LCDE, 11 cases with lobectomy of liver, 7 with ERCP, 3 with percutaneous hepatic puncture.Conclusion: diagnosis methods of intrahepatolithias was dominated by Ultrasonic and CT. To some patients impossible to be diagnosed by Ultrasonic, other methods, such as MRI, ERCP, intraoperative choledochoscopy, could be backup options. As for the treatment principle, removing lesions, relief obstruction and draining should be carried out firstly. Microtrauma operation would replace traditional open abdominal operations gradually, after all, for patients with microtrauma operation, the possibility of inducing complications would shrink sharply. If patients with narrow intra-hepatic bile duct and atrophy of liver lobe had too many calculi in their bile duct, lobectomy of liver should be on top priority of the treatment list. Laparoscopic hepatectomy is a trend to treat this kind of disease. In some hospital where surgeon can resect liver by laparoscopic, laparoscopic hepatectomy can be used if it conforms to indication of laparoscopic hepatectomy. Choledochotomy is a general operation to cure intrahepatolithias. Laparoscopic common bile duct exploration is a trend to treat this kind of disease if the patient has not the operation in abdomen,But the surgeon must be good at operating laparoscopic.If the patient has several operations in abdomen,percutaneous transgepatic choledochoscopy is the best choice. If patients with narrow intra-hepatic bile duct and atrophy of liver lobe had too many calculi in their bile duct, liver transplantation should be taken into account. Liver transplantation for curing intrahepatolithias should be last way...