Experience with Surgical Treatments for Hepatolithiasis

간내결석증의 외과적 치료경험

Hepatolithiasis is characterized by its intractablity and frequent recurrence that requires multiple operative and non-operative interventions. To clarify the optimal treatment modalities and their effectiveness, a total of 648 patients with hepatolithiasis and who had treated at Seoul National University Hospital between January 1981 and December 2005 were analyzed according to the different time periods. Hepatectomy as a primary treatment of hepatolithiasis has gradually increased and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased. New treatment modalities such as percutaneous choledochoscopic stone removal (PTCS) and laparoscopic liver resection were instituted during the past decades. Over the last 25 years, both advances in the operative stone clearance rate and the success rate of postoperative lithotripsy have resulted in an improved final stone clearance rate, and this has been progressive from 79.0% in the first period to 91.3% in the fifth period. In the last 10 years, the final clearance rate of hepatectomy, choledocholithotomy, drainage procedures and PTCS was 97.1%, 82.0%, 78.8% and 85.7%, respectively, and the rate of performing repeated hepatectomy, choledocholithotomy, drainage procedures and PTCS was 11.2%, 26.2%, 9.1% and 28.6% respectively. Hepatolithiasisassociated cholangiocarcinomas were found in 24 (4.7%) patients (1991-2005, n=512), and 5 of them were diagnosed after 5 years of follow-up. Histopathologic examinations of the resected livers showed various degrees of pathologies from proliferative cholangitis and hyperplasia through dysplasia and cholangiocarcinoma. Therefore, a suspicion of malignancy and long term follow-up are needed for managing the patients who suffer with hepatolithiasis.