Abstract
It is certain that the most favorable results can be obtained by hepatic lobectomy in the cases with intrahepatic stones, but the number of patients for whom it can be indicated is practically limited because of the risk of patients or the site and extent of lesions. In those patients in which hepatic lobectomy was impossible to perform, stone-extraction technique suing cholangioscopy is the technology indispensable to get a better therapeutic results.
Since 1974,104 cases of intrahepatic stones have been endoscopically treated in our institute, and stone extraction had been failed in 14 cases. The failure of endoscopic stone-extraction were caused by; 1) accidental removal of the tube placed to maintain the fistula for insertion of cholangiofiberscope in 2 cases,2) the difficult location of lesion for endoscopic stone extraction technique in 7,3) liver cirrhosis in 2, and 4) multiple organ failure (MOF) in 3 cases. The latter 5 cases had passed away. In one of the patients died of MOF due to sepsis caused by liver abscesses, pancreas carcinoma was revealed by autopsy. The causes of the patients who had had these fatal and disastrous complications are attributable to; (1) delayed timing of treatment, (2) insufficient biliary drainage, (3) inadequate selection of surgical procedure, (4) incomplete stone extraction, and (5) coexistence of incurable diseases. These facts suggested how much important the preoperative evaluation of biliary architechture is to get the informations necessary to decide an adequate therapeutic plan. Moreover, importance of complete extraction of stones at the time stones were detected is strongly advocated, because the prognosis would be deteriolated if life threatening complications such as purulent cholangitis, liver abscesses or biliary cirrhosis did once occur.
