Suzuki N, Takahashi W, Sato T
Prog Clin Biol Res. 1984;152:71-80.
The calcium bilirubinate stone is the typical gallstone found in patients with hepatolithiasis; a series of studies on the formation of stones have been performed by Maki [1966, 1982]. Results of chemical analysis and clinical factors lend support to Maki's bacterial beta-glucuronidase theory [Maki, 1966]. However, besides calcium bilirubinate these stones also contain other components such as fatty acids and free bile acids. The presence of these components indicates bacterial involvement, which is proved by the decomposition of the lecithine in bile to fatty acids by phospholipase A and the formation of free bile acids by deconjugation of the conjugated bile acids. In the formation of calcium bilirubinate stones, it is believed that diet [Matsushiro et al, 1977] and bacterial infections accompanying biliary stasis are important inducing elements. Since these stones are formed mainly in the bile ducts and recurrence rates are likely to be high, it is important from the therapeutic viewpoint to remove these inducing factors. However, it is still uncertain whether bacterial infection accompanying biliary stasis should be considered as an inducing factor in the development of fatty acid-calcium stones. More than 90% of all cholesterol and black stones are found in the gallbladder. However, when these stones are found in the intrahepatic bile ducts, it is still not clear whether they are expelled from the gallbladder or formed initially in the intrahepatic bile ducts. In patients who have cholesterol stones filling the entire biliary tract, it is difficult to conceive that these gallstones are first expelled from the gallbladder. In addition, in patients with black stones, the stones are located only in the dilated bile ducts, and stenosis of the bile duct is often recognized in the excisional stump of the liver at lateral segmentectomy. In these cases, the expulsion of stones from the gallbladder seems rather improbable. Different types of gallstones show a tendency to occur in certain regions; however, gallstones may be formed in almost any part of the biliary system if conditions are favorable. It can be concluded that the pathogenesis of hepatolithiasis may not be clarified only by analysis of the intrahepatic gallstones. In addition, an understanding of the formation of different types of gallstones may contribute to elucidation of the pathogenesis of hepatolithiasis.
胆红素钙结石是肝内胆管结石患者中发现的典型胆结石；Maki [1966年，1982年] 对结石形成进行了一系列研究。化学分析结果和临床因素支持了Maki的细菌β-葡萄糖醛酸酶理论 [Maki，1966年]。然而，除了胆红素钙外，这些结石还含有其他成分，如脂肪酸和游离胆汁酸。这些成分的存在表明有细菌参与，这通过磷脂酶A将胆汁中的卵磷脂分解为脂肪酸以及通过结合胆汁酸的去结合形成游离胆汁酸得到证明。在胆红素钙结石的形成过程中，饮食 [Matsushiro等人，1977年] 和伴随胆汁淤积的细菌感染被认为是重要的诱发因素。由于这些结石主要在胆管中形成且复发率可能很高，从治疗角度来看，消除这些诱发因素很重要。然而，胆汁淤积伴随的细菌感染是否应被视为脂肪酸钙结石形成的诱发因素仍不确定。超过90%的胆固醇结石和黑色结石位于胆囊中。然而，当这些结石在肝内胆管中被发现时，它们是从胆囊排出还是最初在肝内胆管中形成仍不清楚。在整个胆道充满胆固醇结石的患者中，很难想象这些胆结石首先是从胆囊排出的。此外，在患有黑色结石的患者中，结石仅位于扩张的胆管中，在肝外侧段切除术的肝切除残端常可发现胆管狭窄。在这些情况下，结石从胆囊排出似乎相当不可能。不同类型的胆结石在某些区域有发生的倾向；然而，如果条件有利，胆结石几乎可在胆道系统的任何部位形成。可以得出结论，仅通过分析肝内胆结石可能无法阐明肝内胆管结石的发病机制。此外，了解不同类型胆结石的形成可能有助于阐明肝内胆管结石的发病机制。
