Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis
Evaluation of long-term results and recurrent factors after operative and nonoperative treatment for hepatolithiasis
复制标题
DOI：
10.1016/j.surg.2009.04.009
复制
发表时间：
2009-11-01
期刊：
影响因子：
3.8
通讯作者：
Shim, Chan Sup
中科院分区：
文献类型：
--
作者：
Cheon, Young Koog;Cho, Young Deok;Shim, Chan Sup
背景肝内胆管结石是东亚地区的常见病。肝内胆管结石的手术和非手术治疗方法已被讨论，但长期随访结果的报道很少。我们评估了手术和非手术治疗的长期结果，并检查了结石或胆管炎复发的危险因素。我们进行了一项回顾性研究的病例记录的肝胆管结石患者接受手术治疗或非手术经皮经皮肝穿刺胆管镜检查（PTCS），或经口胆管镜检查。311例肝内胆管结石患者中，236例接受手术治疗（n = 90）、PTCS（n = 97）或经口胆道镜（n = 49）后随访。83.3%的肝切除术患者、63.9%的PTCSL患者和57.1%的经口胆道镜患者实现了结石完全清除。在中位随访8.0年（最长37年）后，我们观察到30.9%（73/236）的患者结石复发，8.5%（191224）的患者继发胆汁性肝硬化，4.8%（11/227）的患者晚期发展为胆管癌，死亡率为8.1%（19/236）。多因素分析显示，输尿管结石、双叶结石和非手术治疗是结石清除不完全的重要危险因素。此外，复发性结石和/或胆管炎与非手术治疗有关（风险比[HR]，2.01; 95%置信区间[CI]，1.10-3.65），胆汁性肝硬化（HR，2.22; 95% CI，1.24-3.98）、残余结石（HA 1.98; 95% CI，1.24-3.17）和狭窄（HR，1.86; 95% CI，1.01-3.43）。在这项长期随访研究中，非手术治疗、胆汁性肝硬化、残余结石和胆管狭窄与治疗后复发结石和/或胆管炎相关。（外科2009;146;843-53。）
Background. Hepatolithiasis is a common disease in East Asia. Operative and nonoperative procedures for the management of hepatolithiasis have been discussed, but long term follow-up results of such treatments are only reported rarely. We evaluated the long-term results of of operative and nonoperative treatments and examined risk factors for the recurrence of stones or cholangitis.Methods. We conducted a retrospective study of case records of patients with hepalolithiasis who underwent treatment by operative therapy or nonoperative percutaneous transhepatic cholangioscopy (PTCS), or peroral cholangioscopy. Of 311 patients with hepatolithiasis, 236 underwent follow-up after operative (n = 90), PTCS (n = 97), or peroral cholangioscopy (n = 49) treatment.Results. Complete stone clearance was achieved in 83.3% of hepatectomy, 63.9% of PTCSL, and 57.1% of peroral cholangioscopy patients. After a median follow-up period of 8.0 years (up to 37 years), we observed stone recurrence in 30.9% (73/236) of patients, secondary biliary cirrhosis in 8.5% (191224), late development of cholangiocarcinoma in 4.8% (11/227), and a mortality rate of 8.1% (19/236). Stricture, stones in both lobes, and nonoperative treatments were significant risk factors for incomplete stone clearance on multivariate analysis. In addition, recurrent stones and/or cholangitis were associated with nonoperative therapy (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.10-3.65), biliary cirrhosis (HR, 2.22; 95 % CI, 1.24-3.98), residual stones (HA 1.98; 95 % CI, 1.24-3.17), and stricture (HR, 1.86; 95 % CI, 1.01-3.43).Conclusion. In this long-term follow-up study, nonoperative therapy, biliary cirrhosis, residual stones, and biliary stricture were associated with recurrent stones and/or cholangitis after treatment. (Surgery 2009;146;843-53.)