LIVER RESECTION FOR NON-ORIENTAL HEPATOLITHIASIS

ABSTRACT Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.

摘要
背景：原发性肝内胆管结石（Primary intrahepatic lithiasis）指结石形成于肝内，且伴随局部肝内扩张与胆道狭窄。肝切除术是其理想治疗术式。
研究目的：评估肝切除术治疗非东方人群肝内胆管结石的临床疗效。
方法：巴西6家医疗机构共纳入51例伴有症状的良性非东方人群肝内胆管结石患者，均接受手术切除治疗。对患者的人口统计学特征、临床症状、疾病分型、诊断方案、治疗方式及术后病程进行回顾性分析。
结果：51例患者中，男性28例（占比54.9%），平均年龄49.3岁。15例（29.4%）有胆管炎病史。肝内胆管结石分型为I型39例（76.5%）、IIb型12例（23.5%），其中6例（11.8%）合并Ea型病变。42例（82.4%）患者肝功能检查结果正常。12例（23.5%）存在节段性肝萎缩。手术方式包括左外侧段切除术24例（47.1%）、左肝切除术14例（27.5%）、右肝切除术8例（15.7%），其中4例（7.8%）联合实施肝管空肠吻合术。8例（15.7%）患者接受了腹腔镜肝切除术。术后共出现并发症20例（39.2%），无围手术期死亡病例。
结论：肝切除术治疗肝内胆管结石为理想术式，可彻底清除结石病灶、狭窄胆管及萎缩肝实质，并降低胆管癌的发生风险。