The intrahepatic duct (IHD) stone shows diverse spectrum of clinical features such as recurrent cholangitis, obstructive jaundice, liver abscess, biliary cirrhosis and association with cholangiocarcinoma. The result of operative treatment is still not satisfied in spite of many kinds of surgical treatment modalities. The purpose of this study is to elucidate the clinical characteristics and the operative principle of IHD stone by the reviewing the medical records, retrospectively. The 61 patients who received operation at the Department of Surgery, Chungbuk National University Hospital were included in this study. The mean age of the patients is 56 and the age of predilection is sixth and seventh decade. The incidence of IHD stone is higher in females, with a female-to-male ratio of 2.6:1. All of the patients experienced cholangitis more than one episode before operation. The location of IHD stone was 31 patients in left, 8 patients in right, and 21 patients in both IHD. Liver resection was preferred to drainage procedure when the stones were limited to one lobe or segment. 46(75%) cases of liver resection, 11(18%) drainage procedure, 2(3%) T-tube choledocholithomy and 2(3%) open biopsy were performed. Residual stones were found 8 patients(17%) on the liver resection group, 8(61%) on the drainage procedure or T-tube choledocholithotomy group. The patients who had stones in one lobe or limited in the localized part of the liver showed residual stones in one (3%) patients after liver resection. Seven patients(44%) of both IHD stone group who received liver resection, however, had residual stones. There was no postoperative mortality in the liver resection group. IHD stone-associated cholangiocarcinoma was found in 6 patients(10% of studied patients). Three of them were diagnosed during IHD stone operation. The rest was detected after operation(1 - 5 years). Liver resection is the treatment of choice of IHD stone considering residual stones and association with cholangiocarcinoma, especially. These data also suggest that longterm follow-up of the IHD stone patients is needed because of cholangiocarcinoma.
Biopsy ; Cholangiocarcinoma ; Cholangitis ; Chungcheongbuk-do ; Drainage ; Female ; Follow-Up Studies ; Humans ; Incidence ; Jaundice, Obstructive ; Liver ; Liver Abscess ; Liver Cirrhosis, Biliary ; Medical Records ; Mortality ; Retrospective Studies

Pathophysiological conditions such as sepsis and hepatitis are frequently associated with cholestasis. Cholestasis in patients with sepsis has been attributed to the effects of endotoxin(lipopholysaccharides, LPS) and LPS-induced cytokines(TNF-a, IL-6, IL-1, etc.). LPS and cytokines reduced bile acid uptake in cultured hepatocyte. Perfusion of LPS decrease the bile flow in the isolated liver. Bile flow is increased by intravenous infusion of secretin, but it's effect remains unclear in sepsis. The aim, of this study is to elucidate the effect of LPS on the bile flow and bile composition and to test the effect of secretin on the bile flow. The animals used in this study were Korean wild cats. Under the general anesthesia, the incision was made on the midline. Common bile duct was cannulated with polyethylene tube after cholecystectomy. Bile was collected every five minutes and its volume was measured. E. coli LPS(1 mg/kg), secretin(0.1mg/kg) and H3-taurocholic acid(0.2uCi/kg) were infused via mesenteric vein. Bile was collected every 5 minutes, and the volume and its composition were analyzed. Radio-activity of the bile was quantified by Packard 1600 TR liquid scintillation analyzer. LPS of E.coli (1mg/kg) had a little effect on the blood pressure. LPS decreased the bile flow by 37% compared with the control group. Maximal impairment of the bile secretion appeared 15 minites after LPS infusion, and then secreted stablely thereafter. Secretin increased the bile flow in the normal control group. It, however, did not make any change in the bile flow after LPS infusion. LPS also reduced H3-taurocholate secretion(maximum 56%), and peak level was delayed about 10 minites compared with control group. In the composition of the bile, LPS decreased the secretion of bile acids significantly compared with the control group. Conclusively, LPS decreased the bile flow and the bile acid secretion. Secretin did not stimulate the bile flow in the LPS group. It also reduced the bile acids secretion compared with the control group. These findings will contribute to the understanding and treatment of the cholestasis and impairment of the liver function of sepsis. The findings, of reduced bile acids secretion in the LPS group may explain the pathogenesis of intrahepatic gallstone partly.
Anesthesia, General ; Animals ; Bile Acids and Salts ; Bile* ; Blood Pressure ; Cats* ; Cholecystectomy ; Cholestasis ; Common Bile Duct ; Cytokines ; Escherichia coli* ; Escherichia* ; Gallstones ; Hepatitis ; Hepatocytes ; Humans ; Infusions, Intravenous ; Interleukin-1 ; Interleukin-6 ; Liver ; Mesenteric Veins ; Perfusion ; Polyethylene ; Secretin ; Sepsis