Ryu M, Kozu T, Yamazaki Y, Watanabe Y, Yamamoto H, Yamamoto Y, Nagashima T, Ariga T, Usui S, Odaka M
Nihon Geka Gakkai Zasshi. 1984 Sep;85(9):1123-7.
Although hepatolithiasis is a benign disease, its treatment is still the most difficult one in medical field. Before 1977, we had tried bilioenterostomy at the porta hepatis to expect spontaneous dislodgement of stones. However their results were very poor because of frequent occurrence of cholangitis which leads to hepatic failure or death in 8 of 15 patients. From 1977 to 1981, 35 patients had undergone postoperative cholangioscopy (POC). Complete stone removal was obtained in 24 patients. There were 13 difficult local problems in the remaining 11 patients including 6 being too narrow to permit the passage of the fiberscope, 3 having stones incarcerated, 3 having abnormal distribution of biliary tract and one being a missed stone. From 1981, we have carried out percutaneous transhepatic cholangioscopic lithotomy (PTCL) for the treatment of intrahepatic stones in 16 patients. Because abnormal distribution of biliary tract can be easily detected by PTC and incarcerated stones can be made into small pieces before removal following LASER application. We had succeeded in complete stone removal in 12 patients. 2 patients needed biliary reconstruction or liver resection after PTCL. We concluded that for treatment of the disease of intrahepatic stone PTCL should be considered as the first choice before surgery in order to avoid unnecessary hepatic resection or biliary reconstruction.
虽然肝内胆管结石是一种良性疾病，但其治疗仍是医学领域中最棘手的问题之一。1977年以前，我们曾尝试在肝门处行胆肠吻合术，期望结石能自行排出。然而，由于胆管炎频繁发生，其效果很差，15例患者中有8例因胆管炎导致肝衰竭或死亡。1977年至1981年，35例患者接受了术后胆管镜检查（POC）。24例患者结石完全清除。其余11例患者存在13个局部难题，包括6例因胆管过于狭窄纤维镜无法通过、3例结石嵌顿、3例胆道分布异常以及1例结石残留。从1981年起，我们对16例肝内胆管结石患者实施了经皮经肝胆道镜取石术（PTCL）。因为通过经皮肝穿刺胆管造影（PTC）可以很容易地检测到胆道分布异常，并且在应用激光后可以将嵌顿结石粉碎后取出。我们成功地为12例患者完全清除了结石。2例患者在PTCL术后需要进行胆道重建或肝切除。我们得出结论，对于肝内胆管结石疾病的治疗，PTCL应被视为手术前的首选方法，以避免不必要的肝切除或胆道重建。
