Accurate Diagnosis and Rational Treatment for Intrahepatic Stone with Combined Use of Endoscope

Yuji Nimura

lst Department of Surgery, Nagoya University School of Medicine

Although the combined application of choledochoscopy improved the surgical results for intrahepatic stone (IHS), a long follow-up study of this disease revealed the difficulty of achieving complete cure. Sixty-two of 91 cases of IHS treated with PTCS were investigated to evaluate its diagnostic and therapeutic value. This enabled us to make accurate diagnoses of invoved segmental ducts of the liver, true biliary stenosis, biliary dilatation, retained stones, and anatomical findings of the bilary tract. After endoscopic lithotomy, the above-mentioned findings were obtained by direct observation and/or selective cholangiography under PTCS. Hepatic segmentectomy was performed to remove the pathologic lesions of the intrahepatic bile duct, and bile duct resection with hepaticojejunostomy was done to repair the extrahepatic biliary lesions. PTCS was applied in 47 of 70 cases of bilirubin stone and 15 of 21 cases of cholesterol stone, and hepatectomy was added in 15 and 4 of these cases, respectively. Seventy-seven of 91 (84.6%) cases are asymptomatic after treatment. Cholangitis occurred in 7 of 10 symptomatic cases. PTCS was used again in 7 of 8 cases of recurrent or residual stone. Only 1 patient died of endotoxic shock due to recurrent stone with cholangitis. It is suspected that the reason for poor surgical results is improper diagnosis of the involved segmental duct, biliary stenosis and variation of the biliary tract. PTCS solved the above-mentioned problems, leading to satisfactory results. In conclusion, it is emphasized that PTCS should be used as diagnostic and therapeutic endoscopy for IHS.

Key words
intrahepatic stone, endoscopic lithotomy, cholangioscopy

Reprint requests
Yuji Nimura lst Department of Surgery, Nagoya University School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466 JAPAN

Accepted
October 11, 1989

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