Tsuchiya R, Eto T, Tsunoda T, Yamamoto K, Harada N, Koga M, Amano R
Second Department of Surgery, Nagasaki University School of Medicine, Japan.
Gastroenterol Jpn. 1990 Feb;25(1):122-9. doi: 10.1007/BF02785339.
Bilateral intrahepatic lithiasis is a rare condition, and for this reason a nationwide survey was conducted. Reports on 675 patients with bilateral intrahepatic lithiasis over a 10-year-period were collected. Among these, 258 patients with bilateral intrahepatic lithiasis having no extrahepatic bile duct stones were analyzed. The peak incidence was seen in the fourth to sixth decades. Males and females were equally effected. The stones removed were mainly calcium bilirubinate stones (75.6%). The main clinical symptoms were abdominal pain, fever and jaundice. Charcot's triad was seen in 29.7%, while 12.4% of the patients had no symptoms. Visualization of each segmental duct of the liver by direct cholangiography was excellent in this survey and ranged from 88 to 97.3% of the patients. The most frequent site of stones was the left hepatic duct (60.1%). The site of bile duct dilatation coincided with the location of stones. The most common sites of stenosis were the central part of the lateral segmental duct (32.5%) and the left hepatic duct (37.6%). Hepatic resection was employed in 49.2% of the patients, and drainage procedures were added in 95.6%. Follow-up studies of 236 patients treated by surgery revealed good results in 67.4%, fair in 13.6%, and poor in 7.6%. In these patients, however, endoscopic lithotomy was often employed intra- and/or post-operatively. Conducting hepatic resection, with adequate biliary drainage procedure and cholangiofiberscopic lithotomy may help to improve the therapeutic results of bilateral intrahepatic lithiasis.
双侧肝内结石是一种罕见疾病，因此开展了一项全国性调查。收集了10年间675例双侧肝内结石患者的报告。其中，对258例无肝外胆管结石的双侧肝内结石患者进行了分析。发病高峰出现在40至60岁。男性和女性受影响程度相同。取出的结石主要是胆红素钙结石（75.6%）。主要临床症状为腹痛、发热和黄疸。29.7%的患者出现夏科氏三联征，而12.4%的患者无症状。在本次调查中，通过直接胆管造影对肝脏各段胆管的显影效果极佳，88%至97.3%的患者显影良好。结石最常见的部位是左肝管（60.1%）。胆管扩张部位与结石位置一致。最常见的狭窄部位是外侧段胆管中部（32.5%）和左肝管（37.6%）。49.2%的患者接受了肝切除术，95.6%的患者增加了引流手术。对236例接受手术治疗的患者进行随访研究，结果显示良好的占67.4%，中等的占13.6%，差的占7.6%。然而，在这些患者中，内镜取石术常在术中及/或术后使用。进行肝切除术，辅以适当的胆道引流手术和胆管纤维镜取石术，可能有助于提高双侧肝内结石的治疗效果。
