[Management of left and right type intrahepatic stone associated with proximal bile duct stenosis]

Fifty-seven cases of intrahepatic stone were treated in our department from 1976 to 1984. Fifteen cases out of them were left and right type intrahepatic stone associated with the proximal bile duct stenosis. Treatments and results of these 15 cases are discussed. Percutaneous Transhepatic Cholangioscopy (PTCS) was performed in 10 cases, post operative cholangioscopy (POC) in 7 cases. These cases were divided into three groups according to the treatment received. Six patients were treated only with cholangioscopic lithotomy (Group I). Six patients underwent surgical treatment after cholangioscopic lithotomy (Group II). Other 3 patients were treated with POC (Group III). Clinical course of Group I: One patient died of recurrent liver abscess 5 years after PTCS. One died of another disease. One had suffered from empyema 5 years after PTCS, but he is doing well now. Other 3 patients are doing well now. Clinical course of Group II: All patients are doing well now. Clinical course of Group III: All patients underwent treatments for residual stones after POC. Good results were obtained in group II. Surgical treatment after cholangioscopic lithotomy is the best way for these 15 cases. Adequate operative procedure should be applied after improving the patients' condition and making an accurate diagnosis of biliary tract anomalies by means of PTCS.