Preliminary Experience with Indications for Liver Transplantation for Hepatolithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YANG Yong , CHEN Zheyu , YAN Lnan , ZENG Yong , WEN Tianfu , LI Bo , ZHAO Jichun , WANG Wentao , YANG Jiayin , XU Mingqing , MA Yukui , WU Hong

Liver Transplantation Division and Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, ChinaCorresponding Author: YAN Lü-nan, E-mail： yanlunan688@163.com;

Corresponding author：

Keywords：

Liver transplantation; Hepatolithiasis; Surgical treatment; Indication; Complication

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Objective 　To explore the indications for liver transplantation among patients with hepatolithiasis.
Methods 　Data from 1431 consecutive patients with hepatolithiasis who underwent surgical treatment from January 2000 to December 2006 were retrospectively collected for analysis. Surgical procedures included T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones, hepatectomy, cholangiojejunostomy, and liver transplantation.
Results 　Nine hundred and sixty-one patients who had a stone located in the left or right intrahepatic duct underwent hepatectomy or T-tube insertion combined with intraoperative cholangioscopic removal of intrahepatic stones. The rate of residual stones was 7.5% (72/961). Four hundred and seventy patients who had a stone located in the bilateral intrahepatic ducts underwent surgical procedures other than liver transplantation; the rate of residual stones was 21.7% (102/470). Only 15 patients with hepatolithiasis underwent liver transplantation; they all survived. According to the degree of biliary cirrhosis, recipients were divided into 2 groups: a group with biliary decompensated cirrhosis (n=7), or group with biliary compensated cirrhosis or noncirrhosis group (n=8). There were significant differences in operative times, transfusion volumes and blood losses between 2 groups (P＜0.05). In the first group, 6 of 7 patients experienced surgical complications, and in the second, 8 recipients recovered smoothly with no complications. Health status, disability and psychological wellness of all recipients (n=15) were significantly improved in 1 year after transplantation as compared with pretransplantation (P＜0.05).
Conclusion 　Liver transplantation is a possible method to address hepatolithiasis and secondary decompensated biliary cirrhosis or difficult to remove, diffusely distributed intrahepatic duct stones unavailable by hepatectomy, cholangiojejunostomy, and choledochoscopy.

Citation： YANG Yong,CHEN Zheyu,YAN Lnan,ZENG Yong,WEN Tianfu,LI Bo,ZHAO Jichun,WANG Wentao,YANG Jiayin,XU Mingqing,MA Yukui,WU Hong. Preliminary Experience with Indications for Liver Transplantation for Hepatolithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(10): 814-818. doi: Copy

1.	Cheung MT, Wai SH, Kwok PC. Percutaneous transhepatic choledochoscopic removal of intrahepatic stones [Ｊ]. Br J Surg, 2003; 90(11): 1409-1415.
2.	Tsukamoto T, Hirohashi K, Kubo S, et al. Self-expanding metallic stent for benign biliary strictures: seven-year follow-up [Ｊ]. Hepatogastroenterology, 2004; 51(57): 658-660.
3.	Chen DW, Tung-Ping Poon R, Liu CL, et al. Immediate and long-term outcomes of hepatectomy for hepatolithiasis [Ｊ]. Surgery, 2004; 135(4): 386-393.
4.	石景森. 肝内胆管结石的手术方式决择 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 373-374.
5.	邹声泉. 肝内胆管结石的手术选择 [Ｊ]. 中国普外基础与临床杂志, 2002; 9(2): 68-69.
6.	黄志强. 在微创外科时代对肝内胆管结石外科治疗的再认识 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 371-372.
7.	龙胜林, 杨华, 龙先泽, 等. 肝叶切除治疗左肝内胆管结石36例治疗体会 [Ｊ]. 贵州医药, 2008; 32(11): 1012.
8.	Cheung MT, Kwok PC. Liver resection for intrahepatic sto-nes [Ｊ]. Arch Surg, 2005; 140(10): 993-997.
9.	Pan GD, Yan LN, Li B, et al. Liver transplantation for patients with hepatolithiasis [Ｊ]. Hepatobiliary Pancreat Dis Int, 2005; 4(3): 345-349.
10.	Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [Ｊ]. Arch Surg, 2002; 137(2): 149-153.
11.	Hirohashi K, Tanaka H, Kanazawa A, et al. Living-related liver transplantation in a patient with end-stage hepatolithiasis and a biliary-bronchial fistula [Ｊ]. Hepatogastroenterology, 2004; 51(57): 822-824.
12.	Strong RW, Chew SP, Wall DR, et al. Liver transplantation for hepatolithiasis [Ｊ]. Asian J Surg, 2002; 25(2): 180-183.
13.	Yan LN, Lu SC, Li B, et al. Liver transplantation in patients with intrahepatic stones: report of two cases [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(3): 345-348.
14.	黄丽华, 张赛君, 温燕玲. 肝移植患者生活质量及相关因素的调查与分析 [Ｊ]. 中华护理杂志, 2006; 41(7): 589-593.
15.	苏冈, 刘金凤, 陆贯一. 肝脏移植患者围手术期精神状态的调查 [Ｊ]. 中华精神科杂志, 2001; 34(1): 59.
16.	王静, 王晨菲, 丁学易. 肝移植患者术后生活质量的研究进展 [Ｊ]. 中国护理管理, 2007; 7(11): 37-39.
17.	Taylor R, Franck LS, Gibson F, et al. A critical review of the health-related quality of life of children and adolescents after liver transplantation [Ｊ]. Liver Transpl, 2005; 11(1): 51-60.
18.	Yoshida J, Chijiiwa K, Shimizu S, et al. Hepatolithiasis: ou-tcome of cholangioscopic lithotomy and dilation of bile duct stricture [Ｊ]. Surgery, 1998; 123(4): 421-426.
19.	余少鸿, 王晓波. 术中B超定位下经肝胆管取石在肝内胆管结石治疗中的应用价值 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(11): 845-846.
20.	刘天奇, 梁中骁. 复杂肝内胆管结石11例的治疗体会 [Ｊ]. 广西医学, 2008; 30(10): 1588-1589.
21.	姚向庆, 陈燕凌. 原发性肝内胆管结石的治疗进展 [Ｊ]. 医学综述, 2007; 13(8): 583-584.
22.	赵清涛, 张利辉, 崔忠. 肝内胆管结石的外科治疗进展 [Ｊ]. 临床误诊误治, 2007; 20(6): 59-61.
23.	郑树森, 施乾锋. 终末期肝病的肝移植在我国的发展 [Ｊ]. 继续医学教育, 2006; 20(9): 35-37.
24.	Ma YK, Yan LN, Li B, et al. Diagnosis and treatment of bacterial pneumonia in liver transplantation recipients: report of 33 cases [Ｊ]. Chin Med J (Engl), 2005; 118(22): 1879-1885.
25.	钟林, 彭志海. 肝移植后胆道并发症防治的几点体会 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 177-179.
26.	牛秀峰, 刘军. 原位肝移植术后细菌感染的防治 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(3): 162-165.
27.	马毅, 何晓顺, 朱晓峰. 原位肝移植术后胆道并发症的预防和处理 [Ｊ]. 中华医学杂志, 2008; 88(2): 105-107.
28.	Chen MF, Jan YY, Wang CS, et al. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis [Ｊ]. Cancer, 1993; 71(8): 2461-2465.
29.	Liu CL, Fan ST, Wong J. Primary biliary stones: diagnosis and management [Ｊ]. World J Surg, 1998; 22(11): 1162-1166.
30.	黄亮, 周飞国, 晏建军, 等. 肝内胆管结石伴晚期肝内胆管癌临床特点及漏诊原因分析 [Ｊ]. 肝胆外科杂志, 2009; 17(2): 94-96.

1. Cheung MT, Wai SH, Kwok PC. Percutaneous transhepatic choledochoscopic removal of intrahepatic stones [Ｊ]. Br J Surg, 2003; 90(11): 1409-1415.
2. Tsukamoto T, Hirohashi K, Kubo S, et al. Self-expanding metallic stent for benign biliary strictures: seven-year follow-up [Ｊ]. Hepatogastroenterology, 2004; 51(57): 658-660.
3. Chen DW, Tung-Ping Poon R, Liu CL, et al. Immediate and long-term outcomes of hepatectomy for hepatolithiasis [Ｊ]. Surgery, 2004; 135(4): 386-393.
4. 石景森. 肝内胆管结石的手术方式决择 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 373-374.
5. 邹声泉. 肝内胆管结石的手术选择 [Ｊ]. 中国普外基础与临床杂志, 2002; 9(2): 68-69.
6. 黄志强. 在微创外科时代对肝内胆管结石外科治疗的再认识 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(4): 371-372.
7. 龙胜林, 杨华, 龙先泽, 等. 肝叶切除治疗左肝内胆管结石36例治疗体会 [Ｊ]. 贵州医药, 2008; 32(11): 1012.
8. Cheung MT, Kwok PC. Liver resection for intrahepatic sto-nes [Ｊ]. Arch Surg, 2005; 140(10): 993-997.
9. Pan GD, Yan LN, Li B, et al. Liver transplantation for patients with hepatolithiasis [Ｊ]. Hepatobiliary Pancreat Dis Int, 2005; 4(3): 345-349.
10. Uchiyama K, Onishi H, Tani M, et al. Indication and procedure for treatment of hepatolithiasis [Ｊ]. Arch Surg, 2002; 137(2): 149-153.
11. Hirohashi K, Tanaka H, Kanazawa A, et al. Living-related liver transplantation in a patient with end-stage hepatolithiasis and a biliary-bronchial fistula [Ｊ]. Hepatogastroenterology, 2004; 51(57): 822-824.
12. Strong RW, Chew SP, Wall DR, et al. Liver transplantation for hepatolithiasis [Ｊ]. Asian J Surg, 2002; 25(2): 180-183.
13. Yan LN, Lu SC, Li B, et al. Liver transplantation in patients with intrahepatic stones: report of two cases [Ｊ]. Hepatobiliary Pancreat Dis Int, 2002; 1(3): 345-348.
14. 黄丽华, 张赛君, 温燕玲. 肝移植患者生活质量及相关因素的调查与分析 [Ｊ]. 中华护理杂志, 2006; 41(7): 589-593.
15. 苏冈, 刘金凤, 陆贯一. 肝脏移植患者围手术期精神状态的调查 [Ｊ]. 中华精神科杂志, 2001; 34(1): 59.
16. 王静, 王晨菲, 丁学易. 肝移植患者术后生活质量的研究进展 [Ｊ]. 中国护理管理, 2007; 7(11): 37-39.
17. Taylor R, Franck LS, Gibson F, et al. A critical review of the health-related quality of life of children and adolescents after liver transplantation [Ｊ]. Liver Transpl, 2005; 11(1): 51-60.
18. Yoshida J, Chijiiwa K, Shimizu S, et al. Hepatolithiasis: ou-tcome of cholangioscopic lithotomy and dilation of bile duct stricture [Ｊ]. Surgery, 1998; 123(4): 421-426.
19. 余少鸿, 王晓波. 术中B超定位下经肝胆管取石在肝内胆管结石治疗中的应用价值 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(11): 845-846.
20. 刘天奇, 梁中骁. 复杂肝内胆管结石11例的治疗体会 [Ｊ]. 广西医学, 2008; 30(10): 1588-1589.
21. 姚向庆, 陈燕凌. 原发性肝内胆管结石的治疗进展 [Ｊ]. 医学综述, 2007; 13(8): 583-584.
22. 赵清涛, 张利辉, 崔忠. 肝内胆管结石的外科治疗进展 [Ｊ]. 临床误诊误治, 2007; 20(6): 59-61.
23. 郑树森, 施乾锋. 终末期肝病的肝移植在我国的发展 [Ｊ]. 继续医学教育, 2006; 20(9): 35-37.
24. Ma YK, Yan LN, Li B, et al. Diagnosis and treatment of bacterial pneumonia in liver transplantation recipients: report of 33 cases [Ｊ]. Chin Med J (Engl), 2005; 118(22): 1879-1885.
25. 钟林, 彭志海. 肝移植后胆道并发症防治的几点体会 [Ｊ]. 中国普外基础与临床杂志, 2009; 16(3): 177-179.
26. 牛秀峰, 刘军. 原位肝移植术后细菌感染的防治 [Ｊ]. 中国普外基础与临床杂志, 2008; 15(3): 162-165.
27. 马毅, 何晓顺, 朱晓峰. 原位肝移植术后胆道并发症的预防和处理 [Ｊ]. 中华医学杂志, 2008; 88(2): 105-107.
28. Chen MF, Jan YY, Wang CS, et al. A reappraisal of cholangiocarcinoma in patient with hepatolithiasis [Ｊ]. Cancer, 1993; 71(8): 2461-2465.
29. Liu CL, Fan ST, Wong J. Primary biliary stones: diagnosis and management [Ｊ]. World J Surg, 1998; 22(11): 1162-1166.
30. 黄亮, 周飞国, 晏建军, 等. 肝内胆管结石伴晚期肝内胆管癌临床特点及漏诊原因分析 [Ｊ]. 肝胆外科杂志, 2009; 17(2): 94-96.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Preliminary Experience with Indications for Liver Transplantation for Hepatolithiasis

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