Indexing
CÁC SỐ TỪ 2011-2023
Tạp chí Y Dược Học
Abstract
Background: Intrahepatic bile duct stones are common in Southeast Asia and are characterized by complex progression, multiple complications, and challenges in management. Postoperative residual stones and recurrence remain major concerns. This study aimed to evaluate the outcomes of surgical treatment for intrahepatic bile duct stones.
Materials and method: A prospective descriptive study was conducted on 105 patients who underwent surgery for intrahepatic stones from October 2020 to April 2023 at Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital.
Result: The mean age was 55.9 ± 12.6 years, with females accounting for 69.5%; reoperation rate was 72.4%. Common symptoms included right upper quadrant pain (94.3%), fever (41.9%), and jaundice (29.5%). Preoperative complications were acute cholangitis (68.6%), hepatic atrophy (38.1%), and abscess formation (21.9%). Left-sided stones were present in 53.3%, and 81% had concomitant extrahepatic stones. Surgical procedures included common bile duct exploration (46.7%), hepatic resection (44.8%), and biliary−enteric anastomosis (8.6%). The shortest operative time was observed in bile duct exploration (median 150 minutes, IQR 100-170), while the longest occurred in biliary-enteric anastomosis (195.6 ± 49.8 minutes). Postoperative complications occurred in 29.5%, including surgical site infection (21%), residual abscess (6.7%), and bile leakage (2.9%); the highest complication rate was in the hepatic resection group (44.7%). Complete stone clearance was achieved in 61%, highest in hepatic resection (76.6%) and lowest in biliary-enteric anastomosis (44.4%). Stone recurrence was 32.8%, lowest after hepatic resection (19.4%) and highest after biliary enteric anastomosis (75%). Right-sided and bilateral stones were associated with higher residual stone rates. Univariate analysis identified hepatic atrophy, diffuse stones involving ≥3 segments, and hepatic resection as factors related to residual stones. Multivariate analysis showed hepatic resection was the only independent factor, reducing residual stone risk by 0.3-fold.
Conclusion: Hepatic resection, particularly left hepatectomy, is a safe and effective treatment for intrahepatic bile duct stones, improving stone clearance and reducing recurrence. For diffuse, bilateral stones or reoperative cases, a multimodal approach with appropriate intraoperative and postoperative support is essential.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2026 Hue Journal of Medicine and Pharmacy
Hối NĐ, Anh NM. Dịch tễ học bệnh sỏi đường mật. Nhà xuất bản Y học 2012.
Tuấn LQA. Điều trị sỏi đường mật trong gan qua đường hầm ống Kehr bằng ống soi mềm [Luận án Tiến sĩ Y học] 2021.
Hối NĐ, Anh NM. Sỏi đường mật trong gan. Nhà xuất bản Y học 2012.
Suzuki Y, Mori T, Yokoyama M, al. e. Hepatolithiasis: analysis of Japanese nationwide surveys over a period of 40 years. J Hepatobiliary Pancreat Sci. 2014;21(9):617-22.
Khôi LN. Đánh giá kết quả điều trị sỏi trong gan bằng phẫu thuật nối mật-da với đoạn ruột biệt lập và nối mật ruột-da [Luận án Tiến sĩ Y học] 2015.
Hùng VV. Đánh giá hiệu quả điều trị sỏi đường mật trong và ngoài gan bằng phẫu thuật tạo đường hầm ống mật chủ - túi mật - da [Luận án Tiến sĩ Y học] 2015.
Lorio E, Patel P, Rosenkranz L, al. e. Management of Hepatolithiasis: Review of the Literature. Current gastroenterology reports. 2020;22(6):30.
Hong KS, Noh KT, Min SK, al. e. Selection of surgical treatment types for intrahepatic duct stones. Korean J Hepatobiliary Pancreat Surg. 2011;15(3):139-45.
Liu FB, Yu XJ, Wang GB, al. e. Preliminary study of a new pathological evolution-based clinical hepatolithiasis classification. World journal of gastroenterology. 2015;21(7):2169-77.
Ray S, Sanyal S, Das K, al. e. Outcome of surgery for recurrent pyogenic cholangitis: a single center experience. HPB. 2016;18(10):821-6.
Thơ VN. Đánh giá kết quả phẫu thuật điều trị sỏi đường mật chính có nội soi đường mật bằng ống nội soi mềm hỗ trợ [Luận văn Chuyên khoa cấp II] 2020.
Thảo NM. Đánh giá kết quả phẫu thuật cắt gan điều trị bệnh lý sỏi trong gan tại Bệnh viện Trường Đại học Y Dược Huế. Tạp chí Y Dược học - Trường Đại học Y Dược Huế. 2021;13(03):110.
Feng X, Zheng SG, Xia F, al. e. Classification and management of hepatolithiasis: A high-volume,
single-center’s experience. Intractable Rare Dis Res. 2012;1(4):151-6.
Ngọc TH. Đánh giá kết quả phẫu thuật sỏi mật tái phát và sót sỏi đường mật sau mổ [Luận văn Chuyên khoa cấp II] 2020.
Kim HJ, Kim JS, Joo MK, al. e. Hepatolithiasis and intrahepatic cholangiocarcinoma: A review. World journal of gastroenterology. 2015;21(48):13418-31.