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- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2010.3
- 수록면
- 37 - 45 (9page)
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Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis.
Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years.
Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients.
Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.
Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years.
Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients.
Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.
목차
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고찰
참고문헌
참고문헌 (29)
참고문헌 신청
1. [학술지(정기간행물)] - Mori T / 2006 / Gallstone disease: management of intrahepatic stones / Best Pract Res Clin Gastroenterol 20 : 1117 ~ 1137
2. [학술지(정기간행물)] - Park YH / 2004 / Changing patterns of gallstone disease in Korea / World J Surg 28 : 206 ~ 210
3. [학술지(정기간행물)] - Su CH / 1992 / Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study / Dig Dis Sci 37 : 764 ~ 768
4. [학술지(정기간행물)] - Chen XG / 2003 / Clinical epidemiological study on intrahepatic cholelithiasis: analysis of 8585 cases / Hepatobiliary Pancreat Dis Int 2 : 281 ~ 284
5. [학술지(정기간행물)] - 임창섭 / 2008 / 간내결석증의 외과적 치료경험 / 한국간담췌외과학회지 12 (1) : 24 ~ 33
2. [학술지(정기간행물)] - Park YH / 2004 / Changing patterns of gallstone disease in Korea / World J Surg 28 : 206 ~ 210
3. [학술지(정기간행물)] - Su CH / 1992 / Relative prevalence of gallstone diseases in Taiwan. A nationwide cooperative study / Dig Dis Sci 37 : 764 ~ 768
4. [학술지(정기간행물)] - Chen XG / 2003 / Clinical epidemiological study on intrahepatic cholelithiasis: analysis of 8585 cases / Hepatobiliary Pancreat Dis Int 2 : 281 ~ 284
5. [학술지(정기간행물)] - 임창섭 / 2008 / 간내결석증의 외과적 치료경험 / 한국간담췌외과학회지 12 (1) : 24 ~ 33
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UCI(KEPA) : I410-ECN-0101-2014-514-001278173