Kobayashi N, Tanimura H
Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):1093-7.
We analyzed 24 intrahepatic gallstones for their components by chemical assay and evaluation of atomic absorbance. Those with high cholesterol and fatty acid contents were noted in addition to conventional bilirubin-calcium gallstones, and a mean cholesterol content of over 50% was observed in one fourth of the hepatic gallstones. Measurement of biliary bilirubin and calcium levels conducted to investigate the causative factors of bilirubin gallstones showed that they occur more readily in bile containing less bilirubin, suggesting that their development is largely dependent on the amount of bile acids in hepatic bile determined by the biliary acidity, presence of unconjugated bilirubin, and ionization of calcium. Our results suggest the necessity of treating hepatolithiasis as a hepatic disease with constitutional implications and, in the absence of clear insight into its etiology, of selecting surgical modes always with proper consideration to the possibility of recurrence. Therefore, choledochojejunostomy combined with jejunostomy is our primary surgical procedure.
我们通过化学分析和原子吸收评估对24例肝内胆结石的成分进行了分析。除了传统的胆红素钙结石外，还发现了胆固醇和脂肪酸含量较高的结石，并且在四分之一的肝结石中观察到平均胆固醇含量超过50%。为研究胆红素结石的致病因素而进行的胆汁胆红素和钙水平测量表明，胆红素结石更容易在胆红素含量较低的胆汁中形成，这表明它们的形成很大程度上取决于肝胆汁中胆汁酸的含量，而胆汁酸的含量由胆汁酸度、未结合胆红素的存在以及钙的离子化所决定。我们的结果表明，有必要将肝内胆管结石作为一种具有体质影响的肝脏疾病来治疗，并且在对其病因缺乏清晰认识的情况下，在选择手术方式时始终要适当考虑复发的可能性。因此，胆总管空肠吻合术联合空肠造口术是我们的主要手术方法。
