Dilek Osman Nuri, Atasever Ahmet, Acar Nihan, Karasu Şebnem, Özlem Gür Emine, Özşay Oğuzhan, Çamyar Hakan, Dilek Fatma Hüsniye
Department of Surgery, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey.
Department of Radiology, İzmir Katip Çelebi University School of Medicine, İzmir, Turkey.
Turk J Surg. 2020 Dec 29;36(4):382-392. doi: 10.47717/turkjsurg.2020.4551. eCollection 2020 Dec.
Hepatolithiasis (HL) continues to be a problem due to its local and systemic complications, insufficiency in treatment modalities and high risk of recurrence. There are various surgical options available, ranging from endoscopic interventions to a small segment resection and ultimately to transplantation. In this article, patients with the diagnosis of HL and our treatment strategies were evaluated in the light of literature.
The patients diagnosed with HL in our clinic between 2014-2019 were evaluated retrospectively by examining the patient files. Demographic characteristics of the patients, causes of the disease, complications and treatment options were evaluated.
17 patients were included into the study. Mean age of the patients was 64.3 years (range 32-89 years). Seven patients had previous cholecystectomies. Stenosis was found to be developed in hepaticojejunostomy (HJ) site in three patients (two had HJ due to bile duct injury and one had HJ following the Whipple procedure), and in hepaticoduodenostomy site in one patient who had the history of biliary tract injury during cholecystectomy. Two patients with HL without previous cholecystectomies had no gallbladder stones. Nine patients underwent surgery. Left hepatectomy was performed in two patients and lateral sector resection was performed in 2 patients. Two patients with anastomotic stenosis underwent HJ revision and two patients with anastomotic stenosis and one patient with stent ingrowth underwent bifurcation resection and neo-hepaticojejunostomy. Eight patients were followed-up nonoperatively with medical and endoscopic approaches.
Hepatolithiasis is a serious condition that needs to be treated with a multimodal approach. Stenting and anastomotic stenosis facilitate the development of hepatolithiasis and increase the risk of its occurrence. In particular, by performing functional hepaticojejunostomy, the development of this complication will be decreased.
肝内胆管结石（HL）因其局部和全身并发症、治疗方式的不足以及高复发风险，仍然是一个难题。有多种手术选择，从内镜干预到小部分肝切除，最终到肝移植。在本文中，根据文献对诊断为HL的患者及我们的治疗策略进行了评估。
回顾性分析2014年至2019年在我院确诊为HL的患者病历。评估患者的人口统计学特征、病因、并发症及治疗选择。
17例患者纳入研究。患者平均年龄64.3岁（范围32 - 89岁）。7例患者曾行胆囊切除术。3例患者肝空肠吻合术（HJ）部位出现狭窄（2例因胆管损伤行HJ，1例在Whipple手术后行HJ），1例有胆囊切除术中胆道损伤史的患者在肝十二指肠吻合部位出现狭窄。2例未行过胆囊切除术的HL患者无胆囊结石。9例患者接受了手术。2例患者行左肝切除术，2例患者行外侧肝段切除术。2例吻合口狭窄患者行HJ修复术，2例吻合口狭窄患者和1例支架内生患者行肝门部切除及新的肝空肠吻合术。8例患者采用药物和内镜方法进行非手术随访。
肝内胆管结石是一种需要多模式治疗的严重疾病。支架置入和吻合口狭窄会促进肝内胆管结石的发生并增加其发生风险。特别是通过进行功能性肝空肠吻合术，可减少这种并发症的发生。
