Surgical treatment of biliary ductal stricture complicating localized left hepatolithiasis

Table 1 The occurrence rate of each hepatic duct stricture

Location	n	Mild stricture (%)al	Severe stricture (%)a2	Total (%)
Left hepatic duct	112	26 (23.2)	41 (36.6)	67 (59.8)
Left medial hepatic duct	33	9 (27.3)	19 (42.4)	28 (84.8)b
Left external hepatic duct	75	29 (38.7)	34 (45.3)	63 (84.0)d

Mild or severe stricture refers to a stricture with a diameter > or ≤ respectively half of the greatest diameter of the dilated ducts proximal to the stricture. ^a1χ² = 5.26, P > 0.05;

^a2χ² = 4.90, P > 0.05, among 3 groups.

^bχ² = 6.00, P < 0.01;

^dχ² = 11.82, P < 0.01, vs left hepatic duct.

Table 2 Surgical treatment of left hepatic duct stricture and the subsequent re-stricture rates (¯x ± s)

Operative procedures	Cases(%)	Mean follow up period (y)	Re-strictures (%)
Plastic operation plus
Biliary enteric anastomosis	35 (52.2)	9.8 ± 2.7	6 (17.1)f
Severe degree	21 (51.2)	10.6 ± 2.3	4 (19.0)
Mild degree	14 (53.8)	8.6 ± 3.2	2 (14.3)
Left lobectomy	13 (19.4)	9.7 ± 3.0	0 (0.0)e
Severe degree	7 (17.1)	9.1 ± 3.1	0 (0.0)
Mild degree	6 (23.1)	10.3 ± 2.8	0 (0.0)
Stricture repair	6 (9.0)	8.5 ± 3.2	3 (50.0)
Severe degree	4 (9.8)	8.2 ± 3.5	2 (50.0)
Mild degree	2 (7.7)	7.8 ± 10.1	2 (100.0)
Stricture dilation	13 (19.4)	9.9 ± 2.2	12 (92.3)
Severe degree	9 (22.0)	10.7 ± 2.7	9 (100.0)
Mild degree	4 (15.4)	8.1 ± 2.4	3 (75.0)
Total	67 (100.0)	10.1 ± 2.9	21 (31.3)

^fχ² = 19.76, P < 0.01;

^eχ² = 4.69, P < 0.05, vs stricture dilation. No significant difference between severe degree and mild degree.

Table 3 Treatment of strictures of left external hepatic duct and left medial hepatic duct

	Cases	%
Lateral segmentectomy	66	58.9
+Bile duct exploration	39	34.8
+Biliary enteric anastomosis	27	24.1
Left lobectomy	14	12.5
+Bile duct exploration	10	8.9
+Biliary enteric anastomosis	4	3.6
Biliary enteric anastomosis	15	13.4
Bile duct exploration	17	15.2
Total	112	100

Table 4 The rate of correct diagnosis of various bile ducts by different diagnostic procedures

	ERC (%)	PTC (%)	TTC (%)	CT (%)
Total	78	18	106	40
Left external hepatic duct	69 (88.5)	18 (100.0)	96 (90.6)	29 (72.5)
Left medial hepatic duct	16 (20.5)	6 (33.3)	21 (19.8)	12 (30.0)
Extrahepatic duct	78 (100.0)	15 (83.3)	106 (100.0)	36 (90.0)

ERC: Endoscopic retrograde cholangiography; PTC: Percutaneous transhepatic cholangiography; TTC: Trans-T-tube cholangiography; CT: Computed tomography.