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孫基燮,金瓚起 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2
Management of intrahepatic stones has been very complicated and troublesome problems in Korea as well as other countries in East Asia. It is quite differ from gallstones on Americans and Western Europeans, which are mainly located in the gallbladder. The true incidence of the biliary duct stones in Koreans is still uncertain but according to a review of collected series, which were reported in the magazines of Korean Surgical Society, for the last 30 years, the incidence of regions are 43.6% in gallbladder, 42.9% in common bile duct, and 13.5% in intrahepatic duct respectively, and the proportions of both intrahepatic ducts, left hepatic ducts and right hepatic ducts are approximately 52.4%, 36.2%, and 11.5%, nearly 5:4:1 in ratio respectively. It means nearly two thrid of intrahepatic stones are located in the left lobe of liver, and that, the management of left hepatic stones are more obstinate and bothersome than right hepatic stones. It seems to be related with a few reasones include 1) main branches of left hepatic duct makes a right angle, 2) It usually has a stricture at around the point of angulation, 3) As a result of those, bacterial infection is more aggrevated. Until first half of 1970s most of hepatic stones had mainly been treated with surgical intervention in many ways such as by-pass procedures including sphincteroplasty and choledochoduodenostomy, extended choledochojejunostomy, Longmire procedure, Roux-en-Y hepaticojejunostomy and with anchoring jejunal loop, hepatotomy, and lobectomy etc. Since second half of 1970s, a variety of nonsurgical therapy have been developed in many fields including oral bile acid chemolytic therapy, contact solvent dissolution, interventional radioiogy, endoscopic management, extracorporeal shock-wave lithotripsy (ESWL), electro-hydrauric lithotripsy and laser or other fragmentation technologies. Although these have been successfully treated in certain patient with intrahepatic stones and are enthusiastic trials but not always satisfactory, and have had a many limitation by each method only, and that the primary treatment of intrahepatic stones has still remain surgical. The prospect in the future, for the better therapy of hepatic stones we need better organized multidisciplinary therapy incorporating surgery, interventional radiology, and medical therapy etc, and surgical procedures of which suppose to be more simple and less extensive procedures. Instead of conclusion I'd like to present finally my experiences of managment of the hepatic stones especially left side of hepatic stones, namely combined choledocho-hepatochlangioplasty and lithotomy and interventional radiology. The result are as follows: 1. 9 cases, 53.0% were excellent results. 2. 5 cases, 29.4% has had retained stones two of which were removed the stones by interventional radiology.
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