Kondo S, Nimura Y, Hayakawa N, Kamiya J, Shionoya S, Inui K, Nakazawa S
First Department of Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1988 Jan;89(1):116-21.
A case of a 60-year-old man with primary intrahepatic cholesterol gallstone was reported. Several stones, each size 3mm in diameter, were packed in the diverticulum-like dilated part of the posterior-inferior-ventral bile duct branch of the right lobe and 3 stones, each size 3-4mm in diameter, were scattered separately in the lateral segment of the left lobe of which the bile duct branches were diffusely tortuous and with mildly irregular dilatation. Morphologic appearance of the biliary system except in these 2 areas was normal. All stones including a large gallbladder stone consisted of cholesterol. Intraluminal approach, not only ERC but also PTCS, can hardly detect intrahepatic stones of more peripheral areas, although combination of US and enhanced CT may be useful even though bile duct branches are not dilated. We failed in PTCS lithotomy in this case for the first time in our experience with more than seventy cases of intrahepatic stones. However, by PTCS it was possible to investigate the morphology of the biliary system in detail and consequently, to make the diagnosis of primary intrahepatic stones. This patient has cured by cholecystectomy and minimum hepatectomy.
报道了一例60岁男性原发性肝内胆固醇结石病例。数枚直径3mm的结石堆积在右叶肝后下侧胆管分支的憩室样扩张部位，3枚直径3 - 4mm的结石分别散在于左叶外侧段，该段胆管分支弥漫性迂曲且有轻度不规则扩张。除这两个区域外，胆道系统的形态外观正常。所有结石包括一枚大的胆囊结石均由胆固醇组成。腔内途径，不仅是内镜逆行胰胆管造影（ERC），还有经皮经肝胆道镜检查（PTCS），很难检测到更外周区域的肝内结石，尽管超声和增强CT联合使用可能有用，即使胆管分支未扩张。在我们超过70例肝内结石的经验中，该病例首次PTCS取石失败。然而，通过PTCS能够详细研究胆道系统的形态，从而做出原发性肝内结石的诊断。该患者通过胆囊切除术和最小限度肝切除术治愈。
