Shemesh E, Czerniak A, Bar-El J, Schneabaum S, Bat L
Gastroenterology Department, Chaim Sheba Medical Center, Tel-Hasomer, Israel.
Am J Gastroenterol. 1989 Sep;84(9):1055-9.
The clinical presentations of 20 patients with four or more choledochal stones were compared with those of 68 patients who had one to three choledochal stones, investigated during the same time period. All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy. Patients with multiple choledochal stones usually presented with insidious onset of painless jaundice, simulating malignant bile duct obstruction, in contrast to the abrupt onset of cholangitis or pain experienced by patients with one to three stones. The latter patients had an increased number of duodenal diverticula, higher bilirubins, smaller stones, and fewer positive stones as detected by ultrasound of the bile ducts. Cholesterol crystals were more numerous in duodenal aspirates of patients with multiple choledochal stones. We conclude that multiple choledochal stones have a unique, more smoldering clinical presentation, and that ERCP is the diagnostic procedure of choice. Endoscopic sphincterotomy is an efficient, simple, and safe alternative to surgery when there is no cholecystitis.
将20例患有4颗及以上胆总管结石的患者的临床表现与同期调查的68例有1至3颗胆总管结石的患者的临床表现进行了比较。所有患者均接受了内镜逆行胰胆管造影术（ERCP）和内镜括约肌切开术。与有1至3颗结石的患者突发胆管炎或疼痛不同，患有多发胆总管结石的患者通常表现为隐匿起病的无痛性黄疸，类似恶性胆管梗阻。后一组患者十二指肠憩室数量增多、胆红素水平较高、结石较小且经胆管超声检测出的阳性结石较少。多发胆总管结石患者的十二指肠抽吸物中胆固醇结晶更多。我们得出结论，多发胆总管结石有独特的、更为隐匿的临床表现，ERCP是首选的诊断方法。在无胆囊炎的情况下，内镜括约肌切开术是一种有效、简单且安全的手术替代方法。
