La calcolosi intraepatica

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G. NUZZO, G. CLEMENTE, F. GIULIANTE, M. MURAZIO

Ann. Ital. Chir., LXIX, 6, 1998

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A review of one-hundred cases of intra-hepatic lithiasis,
observed between 1967 and 1996 by the same surgical
team, was reported in this paper. There were 61 cases of
migrated stones and 39 cases of primary duct stones (31
above a stenosis and 8 associated to biliary malformations).
83 patients underwent surgery: in 31 cases, gallstones were
removed through the CBD, while a bilio-enteric anasthomosis
was required in 47 cases; 5 patients underwent a left
liver resection. Finally, 17 patients were treated by non-surgical
means (endoscopic or radiologic).
In a first period, diagnosis was made intraoperatively by
cholangiography or choledochoscopy and surgery was the only
therapeutic option. After 1980, diagnostic procedure included
ultrasonography, CT and direct cholangiography (endoscopic
or percutaneous). Consequently to the development of
endoscopic (ERCP) or percutaneous (PTC) approaches to
remove intrahepatic gallstones, many patients were treated
by these non-surgical means, which, in some cases, were
associated with extracorporeal lithotripsy . Abnormalities of
intrahepatic biliary tree represented an elective indication
for liver resection in the last years. The clinical results
improved progressively: mortality was 8,3% in the first ten
years (67-76), 7,1% in the second decade (77-86) and there
was no mortality in the last ten years. In the first decade,
intrahepatic biliary tree was completely cleared from gallstones
in the 70,8% of cases, in the second decade in the
80,9% of cases and, in the last ten years, in the 97% of
cases.

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