Objective: To investigate the clinical characteristics, diagnosis and treatment of the primary cholesterol hepatolithiasis.
Methods:The clinical data of 38 patients with cholesterol hepatolithiasis, who were admitted and underwent surgical treatment from 2007 to 2009, were retropectively analyzed.
Results:The data included 18 male and 20 female patients. The main clinical signs of the patients were abdominal pain, fever and jaundice. Fourteen patients presented with abdominal pain and jaundice (36.8%), 12 patients had abdominal pain with fever (31.5%) and 9 patients presented with Charcot Triad (23.7%). The detection rate of hepatolithiasis before operation by B ultrasonic and CT scan was 100% (38/38) and 77.4% (24/31), respectively. All of the 38 cases underwent surgical treatment that comprised 25 cases of cholecystectomy and bile duct exploration (including re-exploration) with T-tube drainage, 5 cases of internal drainage by Roux-en-Y choledochojejunostomy (with 1 case of reconstruction) and 24 cases of hepatic lobectomy. One case developed postoperative bile leakage and 4 cases developed thoracic complications, such as reactive pleural effusion. Residual stones were found in 3 cases during the period of 6-month follow-up, two of whom had no symptoms and were followed-up by observation, and one complicated by cholangeitis was treated with antibiotics and improved.
Conclusions:Preoperative examination combined with B ultrasonic and CT scan can ascertain the locations of the intrahepatic cholesterol stones and also help in the diagnosis of concomitant diseases. Surgical treatment is the main method to manage cholesterol hepatolithiasis, and the proper employment of hepatic lobectomy and use of cholangioscope results in a low incidence of residual stone.