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임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
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.
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임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),이승은(Seung Eun Lee),강미주(Mee Joo Kang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1
Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.
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