Abstract

Background: Intrahepatic duct (IHD) stones are common disease in Southeast Asia. This is a complicated disease with various complications and difficulties in treatment, with two main problems after treatment including residual stones and recurrent stones. We research pathological characteristics, diagnosis and early surgical results of intrahepatic bile duct stones.

Methods: Descriptive, spective case - control study based on 55 patients who had been diagnosed with benign intrahepatic duct stones, with or without extrahepatic stones, who underwent surgical treatment. Since 01/ 2021 - 06/2022 at Hue Central Hospital.

Results: Mean age is 54,53 ± 11,69 (25 - 81 years old); female/male ratio 2,06; rural areas account for the majority of 58,2%; 81,8% of patients had a history of hepatobiliary disease, of which 72,7% underwent intervention/surgery. Charcot’s triad was present in only 18,2%. Right lower quadrant (RLQ) abdominal pain accounted for 94,5, followed by epigastric pain with 45,5%, fever 43,6%, jaundice 40%, and 43,6% RLQ resistance. 65,5% patients had acute biliary tract infection. WBC count over 10.000/ml accounts for 50%, bilirubin increased in 72,9%, 74% patients with elevated liver enzymes. The common site is intrahepatic combined with extrahepatic stones in 72,7%, intrahepatic stones alone accounted for only 27,3%. Which left liver is dominant in 72,7%. Regarding surgical methods, common bile duct exploration to remove stones with instruments is popular with 34,6%, liver resection in 40%, mostly left liver resection in 36,4%, opening the liver parenchyma to remove stones in 16,4%, opening the hepatico - enterostomy anastomosis to remove stones in 10,9%, hepatico - enterostomy in 3,6%. The average surgical time was 163,18 ± 53,5 minutes (80 - 330 minutes). General complications after surgery in 36,36%, mostly surgical site infection in 20%. Residual stones immediately after surgery accounted for 27,3%. Liver resection group had a longer surgery time (177.9 minutes). Early surgical results: good 56.4%, average 34.5%, bad 9.1%.

Conclusion: Diagnostic of intrahepatic duct stones by clinic, paraclinic, imaging plays an important role in the accurate diagnosis. For effective intrahepatic biliary stone surgery, especially in cases of small or diffuse stones, recurrence, it is necessary to rationally combine stone removal methods, as well as supportive means. About the best result, low complications, reduce to residual stones and recurrent stones.