García Ontiveros A, Cantero Hinojosa J, Gil Extremera B, Miñarro del Moral J
Departamento de Medicina Interna, Hospital Universitario, Granada, España.
Klin Wochenschr. 1990 May 17;68(10):496-502. doi: 10.1007/BF01648240.
Some differences between gallbladder lithiasis and primary common bile duct lithiasis are described. Microbiological cultures and biochemical analyses were carried out on the bile of two groups of patients: 27 suffering from gallbladder and 5 from primary common duct lithiasis. The microstructure and composition of gallstones were also examined by polarized light microscopy and X-ray diffraction. Women predominated in gallbladder lithiasis but not in primary common duct lithiasis group (P less than 0.05) and body weight was higher in the former group (P less than 0.02). Primary common duct lithiasis patients had a higher, although not significant, incidence of duodenal diverticulosis (P = 0.15), and a higher incidence of E. coli-positive cultures in bile (P less than 0.001). No significant difference in the biochemical composition of the bile was found between the groups. Brown pigment stones predominated in primary common duct lithiasis, while cholesterol stones did in gallbladder and secondary common duct lithiasis (P less than 0.0001). Stones formed in the gallbladder generally show linear, radial growths of cholesterol crystals, while those from the common duct present a polystratified, concentric deposition of microgranules composed mainly of pigmentary salts. These differences should be taken into account as additional criteria in the differential diagnosis between primary and secondary common duct lithiasis, as the classical criteria for diagnosing of the former greatly underestimate its actual incidence. The distinction between primary and secondary common duct lithiasis is of practical significance, since each entity requires different treatment.
本文描述了胆囊结石与原发性胆总管结石之间的一些差异。对两组患者的胆汁进行了微生物培养和生化分析：27例胆囊结石患者和5例原发性胆总管结石患者。还通过偏光显微镜和X射线衍射检查了胆结石的微观结构和成分。胆囊结石患者中女性居多，但原发性胆总管结石组并非如此（P<0.05），且前一组患者体重更高（P<0.02）。原发性胆总管结石患者十二指肠憩室病的发病率较高，尽管不显著（P = 0.15），胆汁中大肠杆菌阳性培养物的发生率也较高（P<0.001）。两组之间胆汁的生化成分未发现显著差异。原发性胆总管结石中以棕色色素结石为主，而胆囊结石和继发性胆总管结石中以胆固醇结石为主（P<0.0001）。胆囊中形成的结石通常显示胆固醇晶体呈线性、放射状生长，而胆总管结石则呈现主要由色素盐组成的微粒的多层同心沉积。这些差异应作为原发性和继发性胆总管结石鉴别诊断的附加标准予以考虑，因为诊断前者的经典标准大大低估了其实际发病率。原发性和继发性胆总管结石的区分具有实际意义，因为每种情况需要不同的治疗方法。
