Conzo G, Stanzione F, Celsi S, Candela G, Venetucci P, Palazzo A, Della Pietra C, Santini L, Iaccarino V
Second University of Naples, Italy.
G Chir. 2011 Oct;32(10):424-8.
Hepatolithiasis is defined as the occurrence of stones proximal to the biliary confluence and represents a prevalent disease in South East Asia being uncommon in Western countries. Biliary sepsis, hepatic abscesses and cholangiocarcinoma are considered potential complications. The Authors describe a case of a 68 years male patient affected by a left massive intrahepatic lithiasis secondary to common duct stones and associated to acute pancreatitis. The patient refused surgery and was submitted to a conservative transhepatic percutaneous treatment. After a complete removal of intrahepatic stones and a positioning of external internal biliary drainage (14F), a laparoscopic cholecistectomy was performed. The MRI control showed a complete resolution of the intrahepatic lithiasis. Conservative transhepatic percutaneous approach to hepatolithiasis represents a safe and effective treatment allowing good medium-long term results. Surgery is recommended in case of severe hepatic fibrosis or atrophy, suspected cholangiocarcinoma or multiple strictures with biliary distorsion. Integrated therapeutical protocols in referral multidisciplinary centers-offers the best long term results.
肝内胆管结石是指在胆管汇合处近端出现结石，是东南亚地区的一种常见疾病，在西方国家并不常见。胆源性败血症、肝脓肿和胆管癌被认为是潜在的并发症。作者描述了一例68岁男性患者，患有因胆总管结石继发的左叶巨大肝内胆管结石，并伴有急性胰腺炎。患者拒绝手术，接受了保守的经皮肝穿刺治疗。在完全清除肝内结石并放置了内外胆管引流管（14F）后，进行了腹腔镜胆囊切除术。MRI检查显示肝内结石完全消失。保守的经皮肝穿刺治疗肝内胆管结石是一种安全有效的治疗方法，可取得良好的中长期效果。对于严重肝纤维化或萎缩、疑似胆管癌或伴有胆管扭曲的多处狭窄患者，建议进行手术治疗。在多学科转诊中心采用综合治疗方案可获得最佳的长期效果。
