Otani K, Shimizu S, Chijiiwa K, Ogawa T, Morisaki T, Sugitani A, Yamaguchi K, Tanaka M
Department of Surgery 1, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
J Am Coll Surg. 1999 Aug;189(2):177-82. doi: 10.1016/s1072-7515(99)00109-x.
Hepatic resection and percutaneous transhepatic cholangioscopic lithotomy (PTCSL) are the two main approaches to the treatment of hepatolithiasis, but comparisons of longterm followup results have not been adequately reported.
Of 86 patients with hepatolithiasis admitted to our institution between 1980 and 1996, we reviewed 54 patients: 26 who underwent hepatic resection and 28 who underwent PTCSL. Five patients who underwent postoperative cholangioscopic lithotomy were included in the former group. The remainder of the hepatolithiasis patients were not treated by hepatic resection or PTCSL and, therefore, were excluded from this study. Hepatic resections were mainly indicated for left-sided localized intrahepatic calculi, atrophic liver, and possible presence of cholangiocellular carcinoma. PTCSL was performed for right-sided, bilateral or recurrent stones at an average of 6 treatments (range 1 to 20 treatments) for each patient. There were no differences between the two groups in terms of gender or age. The recurrence rate of stones and longterm prognosis were analyzed using the Kaplan-Meier method, and other clinical factors listed below were statistically compared.
The rate of complete removal of stones was similarly high in each group (96.2% in the hepatic resection group versus 96.4% in the PTCSL group). The complication (38.5% versus 21.4%) and 5-year survival (85.6% versus 100%) rates were comparable. Remaining bile duct stricture (18.2% versus 60.9%, p < 0.01) and 5-year recurrence rates (5.6% versus 31.5%, p < 0.05) were statistically lower in the hepatic resection group than in the PTCSL group.
Hepatic resection, when combined with postoperative cholangioscopic lithotomy, is a preferable treatment for left-sided stones with strictures and bilateral stones.
肝切除术和经皮经肝胆道镜取石术（PTCSL）是治疗肝内胆管结石的两种主要方法，但长期随访结果的比较尚未得到充分报道。
在1980年至1996年间我院收治的86例肝内胆管结石患者中，我们回顾了54例患者：26例行肝切除术，28例行PTCSL。前一组包括5例行术后胆道镜取石术的患者。其余肝内胆管结石患者未接受肝切除术或PTCSL治疗，因此被排除在本研究之外。肝切除术主要适用于左侧局限性肝内结石、肝萎缩以及可能存在胆管细胞癌的情况。PTCSL用于治疗右侧、双侧或复发性结石，每位患者平均接受6次治疗（范围为1至20次治疗）。两组在性别或年龄方面无差异。采用Kaplan-Meier方法分析结石复发率和长期预后，并对以下列出的其他临床因素进行统计学比较。
每组结石完全清除率相似（肝切除组为96.2%，PTCSL组为96.4%）。并发症发生率（38.5%对21.4%）和5年生存率（85.6%对100%）相当。肝切除组残余胆管狭窄（18.2%对60.9%，p<0.01）和5年复发率（5.6%对31.5%，p<0.05）在统计学上低于PTCSL组。
肝切除术联合术后胆道镜取石术是治疗伴有狭窄的左侧结石和双侧结石的优选方法。
