Intrahepatic biliary lithiasis: experience in 20 years

In confirming that intrahepatic gallstones don't represent a frequent disease in western countries, Authors specify how this incidence is going to grow up slowly, but in a progressive way. In reporting their experience since 1980 to nowadays they point out how different diagnostic procedures and therapy way of acting were in the first and in the second deca. After having explained actual therapeutic direction that is described in literature, they finish by stating how this is often conditioned by complex anatomicopathological picture and by seriousness of hepatic damage that often comes with intrahepatic lithiasis.     

Mini invasive treatment of common biliary duct lithiasis

The aim of the paper is to show modern techniques of treatment in common biliary duct lithiasis, in the context of the remarkable development of laparoscopic surgery. The text, trays to mark some directions for the surgeon to know when and which of the modern techniques to chose for safe treatment of common biliary duct lithiasis. The criteria are bound to the moment of diagnosis, clinical state of the patient and laboratory tests. Of course, a final commitment will be taken after an objective evaluation of the technique possibilities and the experience of the team.     

Complications of endoscopic transpapillary interventions

The results of endoscopic papillosphincterotomy with subsequent endobiliary intervention performance in the clinic in 2235 patients in 2000-2006 yrs were studied up. Early complications had occurred in 113 (5.1%) patients, including hemorrhage--in 57 (50%); late complications--in 64 (2.9%). All the patients are alive.     

Choledochoduodenal anastomoses in biliary lithiasis

In choledocholithiasis, after opening the common bile duct, we used to perform choledochoduodenostomy in old patients. The aim of this study was to evaluate our results in 77 patients. The mean age of the patients was 75 years. Twenty-two patients were operated for angiocholitis, 19 had jaundice, and 36 had gallstones without angiocholitis or jaundice. There was two hospital deaths (2.6 p. cent). All the patients but two could be traced. The mean follow-up was 6.7 years. Two patients had had transients episodes of angiocholitis. Twenty-five patients have dead. Expected mortality in french population corresponding in age and sex was 29 deaths. Our results suggest that choledochoduodenostomy is a safe and effective procedure in the management of calculous biliary tract disease for old patients.     

Intrahepatic lithiasis as a late complication of hepaticojejunostomy

The development of intrahepatic lithiasis proximal to a bilodigestive anastomosis is rare. We report a case of intrahepatic lithiasis of the right hepatic duct, which developed almost 6 years after a hepaticojejunostomy performed for an iatrogenic lesion of the common hepatic duct. The patient experienced repeated episodes of acute cholangitis and was treated with intracorporeal lithotripsy and dilation of the stenosis.     

肝内胆管囊腺瘤再次手术临床分析

目的探讨肝内胆管囊腺瘤再次手术的诊治特点。方法回顾性分析总结我院4例肝内胆管囊腺瘤根治性切除术后再次手术的诊治特点。结果肝内胆管囊腺瘤再次手术2例腹胀2例无明显症状,B超、CT、MRI可发现肝内占位难以确诊,再次手术均行根治性切除术,术后病理提示:囊腺瘤复发1例,囊腺癌1例,原发性肝癌1例,肝恶性纤维细胞瘤1例,术后均无明显并发症,随访2例死亡,生存时间为7个月与21个月,1例囊腺瘤痊愈至今未复发,1例肝内胆管囊腺癌随访18个月健在。结论肝内胆管囊腺瘤术后再发肝占位性质难以术前确诊,首选手术治疗,严格术前评估能够获得较好的治疗效果。