Tazuma Susumu, Nakanuma Yasuni
Department of General Internal Medicine, Hiroshima University Hospital and Graduate School of Biomedical & Health Sciences, Hiroshima, Japan.
Department of Human Pathology, Kanazawa University School of Medical Sciences, Kanazawa, Japan.
Lipids Health Dis. 2015 Oct 17;14:129. doi: 10.1186/s12944-015-0130-2.
Hepatolithiasis is a calculus disease of the liver with no known cause that is relatively uncommon, and is characterized by a refractory nature and high frequency of recurrence. Hepatolithiasis is one of the diseases listed by the Ministry of Health, Labour and Welfare of Japan under Research on Intractable Diseases, and it requires further research on the pathogenesis as well as the therapeutic strategy. It is also included in the clinical guidelines for cholelithiasis of the Japanese Society of Gastroenterology, which suggest guiding principles for the treatment of hepatolithiasis.
we performed questionnaire surveys of hepatolithiasis twice in 2010 and in 2012. Verification of the evidence-based clinical practice guidelines a questionnaire survey of 22 facilities in 2010 and 25 facilities in 2012 across Japan that provided cooperation, which enabled us to assess 210 new cases over a two-year period.
Comparison with two surveys that have been carried out previously revealed the main factor associated with hepatolithiasis was a history of biliary tract surgery, which was noted in the majority of cases. In addition, there was an increase of patients in whom balloon endoscopy was performed using transduodenal approach. This method is not included in the treatment options of the current clinical guidelines for cholelithiasis, so there may be a need to take it into consideration when the guidelines are revised.
肝内胆管结石是一种病因不明的肝脏结石疾病，相对少见，具有难治性和高复发率的特点。肝内胆管结石是日本厚生劳动省指定的难治性疾病之一，需要对其发病机制和治疗策略进行进一步研究。它也被纳入日本胃肠病学会胆结石临床指南，该指南提出了肝内胆管结石的治疗指导原则。
我们在2010年和2012年对肝内胆管结石进行了两次问卷调查。对循证临床实践指南进行验证：2010年对日本全国22家提供合作的医疗机构、2012年对25家医疗机构进行问卷调查，这使我们能够在两年时间里评估210例新病例。
与之前进行的两项调查相比，发现与肝内胆管结石相关的主要因素是胆道手术史，大多数病例都有此情况。此外，采用经十二指肠途径进行球囊内镜检查的患者有所增加。这种方法未被纳入当前胆结石临床指南的治疗选择中，因此在修订指南时可能需要考虑将其纳入。
