Percutaneous treatment of intrahepatic lithiasis - 06/05/08
Didier Bonnel [1],
Claude Liguory [1],
Jean-François Lefebvre [1],
François Cornud [1]
Voir les affiliations Correspondence and reprint requests : D.BONNEL, 19, avenue de Tourville, 75007 Paris.Percutaneous treatment of intrahepatic lithiasis |
Aim |
To present our experience with percutaneous intracorporeal electrohydrolic lithotripsy in the treatment of intrahepatic lithiasis.
Subjects and methods |
From January 1989 to November 1998, 53 patients with intrahepatic lithiasis were treated with percutaneous intracorporeal electrohydrolic lithotripsy. Twenty-six patients had primary intrahepatic lithiasis. Intrahepatic stones were associated with intrahepatic duct abnormalities in 11 patients, 9 had strictures and 2 had cystic dilatations. Twenty-seven patients had secondary intrahepatic lithiasis formed a biliodigestive bypass in 20 patients. Intracorporeal electrohydrolic lithotripsy was performed under cholangioscopic guidance in all patients. The endoscope was introduced into the biliary ducts through a cutaneobiliary tract in 51 patients, through a cutaneocholecystic tract in one and through a cutaneojejunal tract in one. These tracts were created and gradually dilated in two sessions three days apart. In twenty-two patients stenosis or sharp angulation prevented adequate positioning of the scope which was only successful after balloon dilation or insertion of a stiff wire.
Results |
Complete clearance of stones was achieved in 49 patients (92 %). Biliary or hepaticojejunostomy strictures were successfully dilated with an angioplasty balloon in all patients. Ten patients (19 %) had early complications: four had bilomas treated by percutaneous drainage, three had resolutive onset of cholangitis, two had transient arterial hemobilia, and one had a pneumothorax. The mean duration of follow-up was five years. During this period, 5 patients (9 %) had recurrent symptoms of biliary obstruction. Among these patients, three (5.7 %) had recurrent symptomatic intrahepatic lithiasis, one had a recurrent biliary stricture and one had secondary sclerosing cholangitis. Treatment of recurrent stones was repeated intracorporeal electrohydrolic lithotripsy in two and left hepatectomy in one; recurrent biliary stricture was treated by hepaticojejunostomy and secondary sclerosing cholangitis by antibiotics.
Conclusion |
Intracorporeal electrohydrolic lithotripsy is effective and safe and should be proposed as the first line treatment of primary or secondary intrahepatic lithiasis.
Plan
© 2001 Elsevier Masson SAS. Tous droits réservés.
Vol 25 - N° 6-7
P. 581-587 - août 2001 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.