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Coexisting sharp ductal angulation with intrahepatic biliary strictures in right hepatolithiasis.
Jeng, K S; Ohta, I; Yang, F S; Liu, T P; Shih, S C; Chang, W S; Wan, H Y; Huang, S H.
Afiliação
  • Jeng KS; Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China.
Arch Surg ; 129(10): 1097-102, 1994 Oct.
Article em En | MEDLINE | ID: mdl-7944942
ABSTRACT

OBJECTIVE:

To investigate the clinical characteristics of a coexisting sharp ductal angulation (< 90 degrees) with biliary stricture and to evaluate the difficulties it imposes in the management of retained or recurrent hepatolithiasis.

DESIGN:

Case-controlled study.

SETTING:

A referral center. PATIENTS Eighteen consecutive patients having right-sided hepatolithiasis and a coexisting sharp ductal angulation associated with biliary stricture (group 1) were compared with 84 patients matched with sex, age, and conditions of hepatolithiasis and intrahepatic biliary stricture(s) but no sharp angulated duct (group 2). INTERVENTION Postoperative cholangioscopic management (electrohydraulic lithotripsy or other lithotripsy, lithotomy, balloon dilation, biopsy, etc, via T-tube tract or percutaneous transhepatic route). MAIN OUTCOME

MEASURES:

Sessions of manipulations, incidence of complications associated with interventions or disease, and mortality were compared.

RESULTS:

Patients of group 1 needed more sessions of postoperative manipulation of stones and strictures (13.7 +/- 4.2 vs 8.0 +/- 2.3; P < .001). During management, there was a significantly increased vulnerability of severe and/or recurrent cholangitis (66.7% vs 9.5%; P < .001), septic shock (77.8% vs 11.9%; P < .001), liver abscess (55.6% vs 7.1%; P < .001), or massive hemobilia (33.3% vs 7.4%) in group 1 than in group 2. Their risks of coexisting secondary biliary cirrhosis (55.6% vs 9.5%; P < .001) and/or cholangiocarcinoma (16.6% vs 2.4%; P < .04) and mortality (27.8% vs 4.8%; P < .01) were also significantly higher in group 1.

CONCLUSION:

Our results suggest that the coexisting sharp ductal angulation with biliary strictures in right-sided hepatolithiasis is a distinct difficult clinical entity in the field of biliary tract calculi.
Assuntos
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ductos Biliares Intra-Hepáticos / Cálculos / Hepatopatias Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 1994 Tipo de documento: Article
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Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Ductos Biliares Intra-Hepáticos / Cálculos / Hepatopatias Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 1994 Tipo de documento: Article