Akiyama T, Nagakawa T, Kanno M, Ohta T, Ueno K, Higashino Y, Konishi I, Miyazaki I, Uogishi M, Sodani H
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Jpn J Surg. 1990 Sep;20(5):530-6. doi: 10.1007/BF02471009.
In order to clarify the pathogenesis and process of the formation of intrahepatic cholesterol gallstones, we examined the clinical features, cholangiograms and pathological findings of eight patients with intrahepatic cholesterol gallstones. When examining the clinical features, one patient was found to have developed intrahepatic cholesterol gallstones 3 years after a complete lithotomy. The cholangiograms of two patients revealed small gallstones in the peripheral bile ducts of the lateral segment of the liver, and these bile ducts showed localized cystic dilatation and were tightly filled with gallstones. Conversely, their other bile ducts which contained no gallstones showed an entirely normal cholangiogram. Pathologically, these two cases showed mild chronic cholangitis, and cholesterol crystals in the peripheral bile ducts. The other six cases showed moderate or severe dilatation of the bile duct and severe chronic proliferative cholangitis. From the above results, we proposed the following theory to explain the pathogenesis and process of the formation of intrahepatic cholesterol stones: The cholesterol crystals in the peripheral intrahepatic bile ducts may be a primitive form of intrahepatic cholesterol gallstones, and the formation of intrahepatic cholesterol gallstones may precede and cause such deformities of the bile ducts as strictures or dilatations.
为阐明肝内胆固醇结石的发病机制及形成过程，我们对8例肝内胆固醇结石患者的临床特征、胆管造影及病理结果进行了检查。在检查临床特征时，发现1例患者在完全取石术后3年出现了肝内胆固醇结石。2例患者的胆管造影显示肝外侧段周边胆管内有小结石，这些胆管呈局限性囊状扩张，且被结石紧密充填。相反，其不含结石的其他胆管胆管造影完全正常。病理检查显示，这2例有轻度慢性胆管炎，周边胆管内有胆固醇结晶。另外6例表现为胆管中度或重度扩张及重度慢性增殖性胆管炎。根据上述结果，我们提出如下理论来解释肝内胆固醇结石的发病机制及形成过程：肝内周边胆管内的胆固醇结晶可能是肝内胆固醇结石的原始形式，肝内胆固醇结石的形成可能先于胆管狭窄或扩张等胆管畸形并导致这些畸形。
