| 摘要 |
As the patterns of gallstone disease have changed, those with recurrent or residual
hepatolithiasis (the so-called complicated hepatoliththiasis) are becoming more and
more problematic. How to treat them properly is a new challenge. Contrast
cholangiography as well as computed tomography or magnetic resonance
cholangiography is necessary to delineate the location of stones, duct strictures, and
possible coexisting malignancy preceding surgical or other biliary interventions.
Resection of the involved segment or lobe of the liver is a safe and effective
treatment for localized hepatolithiasis. Cholangioscopic lithotomy, either
intraoperative, postoperative, or a percutaneous minimally invasive procedure
without reoperation is important in stone eradication. Chemical biliary duct
embolization to prevent stone recurrence has recently been reported. The antagonist
of the epidermal growth factor receptor might suppress proliferative cholangitis in
animal studies. To obtain a good long term outcome, it is important to keep in mind
the possibility of coexisting intrahepatic cholangiocarcinoma, either before, during,
or after treatment of complex hepatolithiasis. For complicated hepatolithiasis, a
systematic approach with multimodal treatment by a cooperative team is
recommended. |
