Surgical treatments for hepatolithiasis complicated with biliary cirrhosis and portal hypertension

Abstract

Objective To investigate surgical treatments for hepatolithiasis complicated with biliary cirrhosis and portal hypertension. Methods Clinical data of 31 patients with hepatolithiasis complicated with biliary cirrhosis and portal hypertension receiving surgical treatments in Nanfang Hospital, Southern Medical University from June 2004 to June 2013 were analyzed retrospectively. There were 21 males and 8 females with the mean age of (49±8) years old. The informed consents of all patients were obtained and local ethical committee approval had been received. The surgical treatments included one-stage cholangiolithotomy (n=26), two-stage cholangiolithotomy (n=5). The perioperative situation and the treatment efficacy were observed. Results The median intraoperative blood loss was 537 (300-1 800) ml for the 26 cases undergoing one-stage cholangiolithotomy. Postoperative bleeding was observed in 2 cases. Pericardial fundus devascularization and transjugular intrahepatic portosystem shunt (TIPS) were performed emergently in the patients respectively and then the bleeding was ceased. The intraoperative blood loss was 350 (300-450) ml for the left 5 cases undergoing two-stage cholangiolithotomy. The liver function of the patients recovered well and no liver failure, hepatic encephalopathy were observed. The postoperative choledochoscope residual rate of calculus was 16% (5/31) and the ultrasound residual rate of calculus was 26% (8/31). Good efficacy was observed in 14 cases and fine in 17 cases. Conclusions The surgical operation for hepatolithiasis complicated with biliary cirrhosis and portal hypertension is with high difficulty and risk. It is necessary to design personalized surgical plan and to perform multiple surgical procedures. Key words: Cholelithiasis; Liver cirrhosis, biliary; Hypertension, portal; Surgical procedures, operative; Portasystemic shunt, surgical; Portasystemic shunt, transjugular intrahepatic; Individualized medicine