No abstract available.
Bile Ducts, Intrahepatic

PURPOSE: Various treatments have recently been applied for hepatolithiasis and their results also have been reported. We introduce herein a new surgical technique, the Ventral Hilar Exposure Method, for hepatolithiasis. This method has been performed for the last ten years at our hospital, and we now report the results of this procedure. METHODS: We evaluated the outcomes of 128 patients among 153 patients who had received hepatectomy with the method of ventral hilar exposure for hepatolithiasis at our hospital from June 1994 to June 2004. We analyzed the rates of residual and recurrent stone, the risk of the treatment and the rate of concomitant cholangiocarcinoma. With these results, we evaluated the utility of the ventral hilar exposure method for hepatolithiasis. RESULTS: There was no post-operative mortality and severe complications in the 128 patients who had received hepatectomy by the ventral hilar exposure method. Among those patients, the rate of residual stone and recurrent stone were 5.4% and 4.2%, respectively. The rate of concomitant cholangiocarcinoma was 11%. CONCLUSION: The ventral hilar exposure method hepatectomy is safe and it shows a more improved treatment result for hepatolithiasis. We think that the direct exploration of intra-hepatic hilar bile duct structure during hepatectomy resulted in the improved outcomes. Therefore, we recommend this procedure of hepatectomy as a standardized surgical treatment method for hepatolithiasis.
Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; Hepatectomy ; Humans ; Mortality ; Recurrence

BACKGROUND: The relationship between hepatoliths and cholangiocarcinoma is etiologically unclear. However, histogenetic sequencing with hyperplasia, dysplasia and carcinoma can occur in the bile ducts of hepatolithiasis. METHODS: We studied 55 cases of hepatolithiasis and examined the specimens of resected liver tissue with a microscope. The growth patterns of bile duct epithelium were divided into four types: flat, tufting, micropapillary and papillary. The dysplasia was also divided into low-grade dysplasia (LGD) and high-grade dysplasia (HGD). RESULTS: Of 55 cases of hepatolithiasis, 30 cases (54.6%) were of the flat pattern, 13 cases (23.6%) the micropapillary pattern, and 11 cases (20%) the tufting pattern. Epithelial hyperplasia was noted in only 36 cases (65.5%) in the large bile ducts, but dysplastic changes were found in 19 cases. Of 19 cases of dysplasia, LGD was present in 14 cases (25.5% of total 55 cases) an HGD in 5 cases (9% of total 55 cases). The epithelial hyperplasia showed histologic growth of the flat pattern in 29 cases out of 36 cases. But LGD (14 cases) had 6 cases of the tufting pattern and 7 cases of the micropapillary pattern. HGD (5 cases) revealed 4 cases of the micropapillary pattern with one case of the tufting pattern. CONCLUSION: This study suggests that sequences of hyperplasia, low-grade dysplasia and high-grade dysplasia can play a role in the carcinogenesis of bile duct epithelium in hepatolithiasis with the histologic pattern changing from flat to micropapillary growth.
Bile Ducts ; Bile Ducts, Intrahepatic* ; Carcinogenesis ; Cholangiocarcinoma ; Epithelium* ; Hyperplasia ; Liver*

Clonorchiasis procucts diffuse dilatation of the small and medium sized intrahepatic bile ducts and its cholangiogram shows visualization of many bile ducts, especially, tertiary, quaternary, and more peripheral tributaries up to the 6th tributaries. In an attempt to clarify this cholangiographic sign quantitively, we counted the visualized smaller bile ducts in clonorchiasis and compared the number of visualized ducts in normal cholangiogram, recurrent pyogenic chlangitis and carcinoma of the extrahepatic ducts. In clonorchiasis the number of visualized smaller bile ducts was considerably geater than in normal subjects and recurrent pyogenic cholangitis, but there was no singnificant statistical differences in the number of visualized bile duct tributaries between clonorchiasis and carcinoma of the bile ducts. Thus it is considered that too many ducts sign is not a unique cholangiographic finding of clonorchiasis, but we believe that in the presence of this sign with other we l known cholangiographic findings, diagnosis of clonorchiasis is very easy.
Bile Ducts ; Bile Ducts, Intrahepatic ; Cholangitis ; Clonorchiasis* ; Diagnosis ; Dilatation

Intraductal papillary neoplasms of the bile duct (IPNBs) are known to show various pathologic features and biological behaviors. Recently, two categories of IPNBs have been proposed based on their histologic similarities to pancreatic intraductal papillary mucinous neoplasms (IPMNs): type 1 IPNBs, which share many features with IPMNs; and type 2 IPNBs, which are variably different from IPMNs. The four IPNB subtypes were re-evaluated with respect to these two categories. Intestinal IPNBs showing a predominantly villous growth may correspond to type 1, while those showing papillay-tubular or papillay-villous growth correspond to type 2. Regarding gastric IPNB, those with regular foveolar structures with varying numbers of pyloric glands may correspond to type 1, while those with papillary-foveolar structures with gastric immunophenotypes and complicated structures may correspond to type 2. Pancreatobiliary IPNBs that show fine ramifying branching may be categorized as type 1, while others containing many complicated structures may be categorized as type 2. Oncocytic type, which displays solid growth or irregular papillary structures, may correspond to type 2, while papillary configurations with pseudostratified oncocytic lining cells correspond to type 1. Generally, type 1 IPNBs of any subtype develop in the intrahepatic bile ducts, while type 2 IPNBs develop in the extrahepatic bile duct. These findings suggest that IPNBs arising in the intrahepatic ducts are biliary counterparts of IPMNs, while those arising in the extrahepatic ducts display differences from prototypical IPMNs. The recognition of these two categories of IPNBs with reference to IPMNs and their anatomical location along the biliary tree may deepen our understanding of IPNBs.
Bile Ducts ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Bile ; Biliary Tract ; Cholangiocarcinoma ; Gastric Mucosa ; Mucins

OBJECTIVE: Intrahepatic stones provide a quite different spectrum of problems faced by surgeons in the Eastern hemisphere. Although unilateral left intrahepatic stones have been treated by left hepatic lobectomy, bilateral or right intrahepatic stones can be even more troublesome because they frequently cannot be completely removed by conventional surgical stone extraction procedure. Recently, the use of a flexible fiberoptic choledochoscope, electrohydraulic lithotriptor(EHL) and dilators make it possible to completely remove intrahepatic stones by nonsurgical procedures in the majority of cases. METHODS: During the last 5 years, we treated intrahepatic stones in 114 patients with a fiberoptic choledochoscope, EHL and dilators via percutaneous transhepatic route. For construction of percutaneous transhepatic routes, we punctured intrahepatic ducts by ultrasonographic guidance and then dilated the tracts by PTBD set(Nipro Co., Japan) under fluoroscopic guidance. Choledochoscopy were performed at 4-6 weeks later, and Dormina basket, EHL, balloon or bougie dilators were used for removal of stones. RESULTS: Success rates according to the locations of stones were 87.5%(14/16) in unilateral right intrahepatic stones, 92.9%(39/42) in unilateral left intrahepatic stones, and 89.3%(50/56) bilateral intrahepatic stones. Overall success rate was 90.4%(103/114). Causes of incomplete removal of the stones in our patients included the failure of construction or maintenance of percutaneous transhepatic routes in 4 cases, intrahepatic bile duct stricture proximal to impacted stones in 3, acute ductal angulation in 2, and stones located at the very distal branches of intrahepatic ducts in 2 cases. Complications associated with the procedure were transient fever in 8 cases, severe hemobila in 2 cases and biliary perforation in 3 cases. CONCLUSON: These results suggest that percutaneous transhepatic choledochoscopic approach is a relatively safe and effective method for treatment of intrahepatic stones.
Bile Ducts, Intrahepatic ; Constriction, Pathologic ; Fever ; Humans

Bile Ducts, Intrahepatic ; Dilatation, Pathologic ; Humans ; Synchrotrons

Adolescent ; Bile Ducts, Intrahepatic ; abnormalities ; Cholestasis, Intrahepatic ; etiology ; Humans ; Male

The recommended surgical method for treating congenital biliary dilation is excision of the entire extrahepatic bile duct, with a hepaticoenterostomy to stop reflux and stasis of pancreatic secretions in the gallbladder and dilated bile duct. Late complications of surgical treatment include anastomotic strictures, cholangitis, and stone formation in the intrahepatic bile ducts. This report describes a very rare late complication, in which protein stones formed in a remnant choledochal cyst in the pancreas 23 years after resection of a congenital choledochal cyst. Our case highlights the necessity for complete cyst resection as close as possible to the portion buried in the pancreatic bed at the time of primary choledochal cyst resection.
Bile Ducts ; Bile Ducts, Extrahepatic ; Bile Ducts, Intrahepatic ; Cholangitis ; Choledochal Cyst ; Constriction, Pathologic ; Gallbladder ; Pancreas

Bile Duct Neoplasms ; surgery ; Bile Ducts, Intrahepatic ; Cholangiocarcinoma ; surgery ; Humans