PDF(Pubmed)
Abstract：
BACKGROUND: Despite being a benign disease, hepatolithiasis has a poor prognosis because of its intractable nature and frequent recurrence. Nonsurgical treatment is associated with high incidences of residual and recurrent stones. Consequently, surgery via hepatic lobectomy or segmental hepatectomy has become the main treatment modality. Clinical management and resolution of complicated hepatolithiasis with bilateral or diffuse intrahepatic stones remain very difficult and challenging. Repeated cholangitis and calculous obstruction may result in secondary biliary cirrhosis, a limiting factor in the treatment of hepatolithiasis.
METHODS: A 53-year-old woman with a 5-year history of intermittent abdominal pain and fever was admitted to the hepatopancreatobiliary surgery department following worsening symptoms over a 3-d period. Blood tests revealed elevated transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin, as well as anemia. Magnetic resonance cholangiopancreatography showed dilatation of the intrahepatic, left and right hepatic, common hepatic, and common bile ducts, and multiple short T2 signals in the intrahepatic and common bile ducts. Abdominal computed tomography showed splenomegaly and splenic varices. The diagnosis was bilateral hepatolithiasis and choledocholithiasis with cholangitis. Surgical treatment included hepatectomy of segments II and III, cholangioplasty, left hepaticolithotomy, second biliary duct exploration, choledocholithotomy, T-tube drainage, and accretion lysis. Surgical and pathological findings confirmed secondary biliary cirrhosis. Liver-protective therapy and anti-infectives were administered. The patient developed liver and respiratory failure, severe abdominal infection, and septicemia. Eventually, her family elected to discontinue treatment.
CONCLUSIONS: Liver transplantation, rather than hepatectomy, might be a treatment option for complicated bilateral hepatolithiasis with secondary liver cirrhosis.
METHODS: A 53-year-old woman with a 5-year history of intermittent abdominal pain and fever was admitted to the hepatopancreatobiliary surgery department following worsening symptoms over a 3-d period. Blood tests revealed elevated transaminases, alkaline phosphatase, γ-glutamyl transpeptidase, and total bilirubin, as well as anemia. Magnetic resonance cholangiopancreatography showed dilatation of the intrahepatic, left and right hepatic, common hepatic, and common bile ducts, and multiple short T2 signals in the intrahepatic and common bile ducts. Abdominal computed tomography showed splenomegaly and splenic varices. The diagnosis was bilateral hepatolithiasis and choledocholithiasis with cholangitis. Surgical treatment included hepatectomy of segments II and III, cholangioplasty, left hepaticolithotomy, second biliary duct exploration, choledocholithotomy, T-tube drainage, and accretion lysis. Surgical and pathological findings confirmed secondary biliary cirrhosis. Liver-protective therapy and anti-infectives were administered. The patient developed liver and respiratory failure, severe abdominal infection, and septicemia. Eventually, her family elected to discontinue treatment.
CONCLUSIONS: Liver transplantation, rather than hepatectomy, might be a treatment option for complicated bilateral hepatolithiasis with secondary liver cirrhosis.
摘要：
背景：尽管是良性疾病，肝胆管结石由于其顽固性和经常复发，预后较差。非手术治疗与残余和复发性结石的高发生率相关。因此,通过肝叶切除或肝段切除手术已成为主要的治疗方式。复杂肝胆管结石伴双侧或弥漫性肝内结石的临床治疗和解决仍然非常困难和具有挑战性。反复胆管炎和结石性梗阻可导致继发性胆汁性肝硬化，治疗肝胆管结石的限制因素。
方法：一名53岁女性，有5年的间歇性腹痛和发热病史，在3天的时间内症状恶化后进入肝胰胆管外科。血液检查显示转氨酶升高,碱性磷酸酶,γ-谷氨酰转肽酶,和总胆红素,以及贫血。磁共振胰胆管造影显示肝内扩张，左肝和右肝，普通肝，和胆总管,以及肝内和总胆管中的多个短T2信号。腹部计算机断层扫描显示脾肿大和脾静脉曲张。诊断为双侧肝胆管结石和胆总管结石伴胆管炎。手术治疗包括II和III段肝切除术，胆管成形术,左肝切除术,第二次胆道探查,胆总管切开取石术,T型管引流,和吸积溶解。手术和病理结果证实继发性胆汁性肝硬化。给予肝脏保护治疗和抗感染药物。病人出现了肝和呼吸衰竭,严重的腹部感染,和败血症。最终,她的家人选择停止治疗。
结论：肝移植，而不是肝切除术，可能是复杂的双侧肝胆管结石伴继发性肝硬化的治疗选择。
方法：一名53岁女性，有5年的间歇性腹痛和发热病史，在3天的时间内症状恶化后进入肝胰胆管外科。血液检查显示转氨酶升高,碱性磷酸酶,γ-谷氨酰转肽酶,和总胆红素,以及贫血。磁共振胰胆管造影显示肝内扩张，左肝和右肝，普通肝，和胆总管,以及肝内和总胆管中的多个短T2信号。腹部计算机断层扫描显示脾肿大和脾静脉曲张。诊断为双侧肝胆管结石和胆总管结石伴胆管炎。手术治疗包括II和III段肝切除术，胆管成形术,左肝切除术,第二次胆道探查,胆总管切开取石术,T型管引流,和吸积溶解。手术和病理结果证实继发性胆汁性肝硬化。给予肝脏保护治疗和抗感染药物。病人出现了肝和呼吸衰竭,严重的腹部感染,和败血症。最终,她的家人选择停止治疗。
结论：肝移植，而不是肝切除术，可能是复杂的双侧肝胆管结石伴继发性肝硬化的治疗选择。
