| 摘要 |
Intrahepatic stones (hepatolithiasis), characterized by recurrent cholangitis and liver abscess, is prevalent in East Asia in comparison to western countries, and is responsible for serious morbidity. During a period of 15 years, information on a total of 541 patients of this hospital with verified hepatolithiasis was collected to retropectively analyze their clinical features
including age, sex, clinical presentations, complications, treatment and outcome. Of these 541 patients, hepatolithiasis was encountered more frequently in females than males (1 : 0. 75), and predominated in middle age (41 ~ 50 years). Abdominal ultrasonography, endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography or abdominal computerized tomography were utilized to confirm diagnoses. The location of stone distribution was 53.4 % at left intrahepatic ducts, 21.8% at right, and 24.8% in both lobes. In addition, 24.6% had intrahepatic stones only, 51.7% had coexistent common bile duct stones, 4.3% had coexistent gallbladder stones, and 19.4 % had stones in the entire biliary system (intrahepatic ducts, common bile duct and gallbladder). Abdominal pain (68.2%) was the leading symptom, while jaundice （是6.4%), fever (45.8%) and cholangitis (30.7%) were also usual as the initial presentations. Sepsis (17.7%), liver abscess (10.4% ) and pancreatitis (7.4%) may be complicated with hepatolithiasis, especially in patients with coexistent extrahepatic stones. The most common organism isolated in sepsis and liver abscess was E. coli. Surgery was the main therapy in our series. Of the 388 (71.7%) patients who underwent operation, extended choledocholithotomy was performed in 289 patients while segmentectomy or lobectomy was done in the remaining 99 patients. There were 153 (28.3%) patients who were treated medically by antibiotics and drainage procedures. Mortality rate in this series was 4.1 %, and usually because of sepsis. Residual or recurrent stones after surgical procedures remain difficult to resolve. With sepsis as the leading cause of death, optimal control of infection is crucial in patients with hepatolithiasis and coexistent extrahepatic stones, not only to prevent the morbidity of liver abscess and stone recurrence but also to reduce the mortality rate. |
