Nuzzo Gennaro, Clemente Gennaro, Giovannini Ivo, De Rose Agostino M, Vellone Maria, Sarno Gerardo, Marchi Domenico, Giuliante Felice
Department of Surgery, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart, "A. Gemelli" Medical School, Largo Gemelli 8, 00168 Rome, Italy.
Arch Surg. 2008 Jun;143(6):570-3; discussion 574. doi: 10.1001/archsurg.143.6.570.
Primary intrahepatic lithiasis occurs frequently in East Asia but is rare in Western countries. Biliary pain and episodes of cholangitis are the most common presenting symptoms, whereas intrahepatic cholangiocarcinoma represents a long-term unfavorable complication of the disease. When a single liver lobe or segment is involved, partial hepatectomy may be regarded today as an effective method of treatment.
Retrospective study.
Hepatobiliary unit in a tertiary care hospital.
The clinical records of 35 patients treated for primary intrahepatic lithiasis between January 1, 1992, and December 31, 2005, were reviewed and clinical data, cholangiograms, operative procedures, and early and late results were examined.
Thirty-four patients underwent liver resection; left hepatectomy (18 patients) and left lateral segmentectomy (10 patients) were the most frequently performed procedures. A cholangiocarcinoma was found in 3 patients (8.6%): 2 underwent liver resection and 1, who was found unresectable at surgery, underwent only explorative laparotomy.
Survival, quality of life, laboratory data, and need for further treatments.
There was no postoperative mortality. Morbidity was 20.0% with a prevalence of infectious complications related to bile leakage. Long-term results, assessed in 26 patients with follow-up longer than 12 months (range, 12-170 months; mean, 63 months), were good or fair in 24 patients (92.3%), including 3 patients who needed subsequent endoscopic removal of biliary stones.
Primary intrahepatic lithiasis more commonly involves 1 single liver segment or lobe. Partial hepatectomy is a safe and effective procedure, allowing definitive treatment of the disease and prevention of cancer.
原发性肝内胆管结石在东亚地区高发而在西方国家罕见。胆绞痛和胆管炎发作是最常见的临床表现，而肝内胆管癌是该疾病长期不良的并发症。当单个肝叶或肝段受累时，如今肝部分切除术可被视为一种有效的治疗方法。
回顾性研究。
一家三级护理医院的肝胆科。
回顾了1992年1月1日至2005年12月31日期间接受原发性肝内胆管结石治疗的35例患者的临床记录，并检查了临床数据、胆管造影、手术操作以及早期和晚期结果。
34例患者接受了肝切除术；左肝切除术（18例患者）和左外叶切除术（10例患者）是最常施行的手术。3例患者（8.6%）发现有胆管癌：2例接受了肝切除术，1例在手术中发现无法切除，仅接受了剖腹探查术。
生存率、生活质量、实验室数据以及进一步治疗的需求。
无术后死亡病例。发病率为20.0%，以与胆漏相关的感染性并发症为主。对26例随访时间超过12个月（范围12 - 170个月；平均63个月）的患者进行长期结果评估，24例患者（92.3%）结果良好或尚可，其中3例患者随后需要内镜下取出胆管结石。
原发性肝内胆管结石更常累及单个肝段或肝叶。肝部分切除术是一种安全有效的手术，可对该疾病进行确定性治疗并预防癌症。
