[The role of endoscopic lithotomy in the treatment of intrahepatic stones].

Although hepatolithiasis is a benign disease, its treatment is still the most difficult one in medical field. Before 1977, we had tried bilioenterostomy at the porta hepatis to expect spontaneous dislodgement of stones. However their results were very poor because of frequent occurrence of cholangitis which leads to hepatic failure or death in 8 of 15 patients. From 1977 to 1981, 35 patients had undergone postoperative cholangioscopy (POC). Complete stone removal was obtained in 24 patients. There were 13 difficult local problems in the remaining 11 patients including 6 being too narrow to permit the passage of the fiberscope, 3 having stones incarcerated, 3 having abnormal distribution of biliary tract and one being a missed stone. From 1981, we have carried out percutaneous transhepatic cholangioscopic lithotomy (PTCL) for the treatment of intrahepatic stones in 16 patients. Because abnormal distribution of biliary tract can be easily detected by PTC and incarcerated stones can be made into small pieces before removal following LASER application. We had succeeded in complete stone removal in 12 patients. 2 patients needed biliary reconstruction or liver resection after PTCL. We concluded that for treatment of the disease of intrahepatic stone PTCL should be considered as the first choice before surgery in order to avoid unnecessary hepatic resection or biliary reconstruction.