The New Epidemiological Features And Treatment Strategies Of Intrahepatic Lithiasis

Object:Secondary intrahepatic lithiasis was lack of attention and systematic research. This study was designed to review and analysis the cases of intrahepatic lithiasis in 301 hospital for 10 years, and depicted the characteristics and prognosis of the secondary intrahepatic lithiasis. Then revealed the epidemiological characteristics, the clinical features and the prognostic featuresof the secondaryintrahepatic lithiasis, and improved the attention to secondaryintrahepatic lithiasis, and try to generalize the treat strategies.Methods:There were three parts in the article. The first part was the study of the epidemiological characteristics of secondary intrahepatic lithiasis, to review the 1052 cases of intrahepatic lithiasis during 1 January 2005 to 31 December 2014 in the hepatobiliary surgery department of 301 Hospital.According to the primary cause, the cases were divided into primary intrahepatic lithiasis (PIL) and Secondary intrahepatic lithiasis (SIL), and analyzed the basic information, causes, stone distribution, classification, clinical signs, laboratory examination, complications, and surgical information. The second part was the study of prognosis. In this part, we compared the perioperative indicators, postoperative stone clearance rate, compared the rate of well prognosis and performed the Cox regression to pick out the independent risk factors of SIL. The third part was the study of strategies of the treatment of SIL. We analyzed three typical cases of SIL, which caused by choledochal cyst, bile duct injury and the endoscopic sphincterotomy.Results:There were 813 cases of PIL and 205 cases of SIL in total 1018 cases of intrahepatic lithiasis. SIL had stabilized over one third to intrahepatic lithiasis after 2010. Compared with PIL patients, the SIL patients were younger and more ratio of history of bile duct surgery. The statistics showed that main causes of SIL were choledochal cysts, duodenal sphincterotomy. and stomach anastomosis, cavernous transformation of the portal vein, bile duct injury. The time consumed by different causes has significant differences. There were less type I and more type Ⅱ, and more abdominal pain and fever but less jaundicein SIL. More cholangioenterostomy and less hepatectomy were applied in SIL. There were 34 cases combined intrahepatic lithiasis with carcinoma, and five SIL patients among them. The hospitalized time of SIL was longer, and no difference in the complication rate between PIL and SIL. There was no difference in stone clear rate between PIL and SIL, however, There were significant different among different causes in SIL patients. The rate of good prognosis of SIL was 84.02%, and various according to different causes. Independent risk factors associated with prognosis included age, residual stone after operation and whether cirrhosis.Conclusions:The proportion of secondary intrahepatic lithiasis has been increasing and has been a new epidemiological feature of intrahepatic lithiasis. Compared to primary intrahepatic lithiasis, secondary has its own clinical manifestations, pathological type, surgical approach, and prognosis features, which close relate to the primary cause. According to the features of secondary intrahepatic lithiasis, to develop targeted means should lead to hepatobiliary surgery practitioner’s attention.