Cameron J L, Gayler B W, Sanfey H, Milligan F, Kaufman S, Maddrey W C, Herlong H F
Ann Surg. 1984 Jul;200(1):54-60. doi: 10.1097/00000658-198407000-00009.
The cholangiograms of 36 patients with sclerosing cholangitis were reviewed. The mean age of the patient group was 43 years, and the mean disease duration was 4.5 years. Seventeen of the patients had associated inflammatory bowel disease. The mean serum bilirubin was 6.8 mg/dl, the mean SGOT was 105 IU/L, the mean SGPT was 108 IU/L, and the mean serum alkaline phosphatase was 534 IU/L. The cholangiograms demonstrated involvement of the extrahepatic bile ducts in 33 patients, involvement of the hepatic duct bifurcation in 33 patients, and involvement of the intrahepatic bile ducts in 35 patients. The cholangiograms were graded as to the areas of the most severe obstructive involvement. In 24 patients the area of most severe involvement was the hepatic duct bifurcation. In eight additional patients the hepatic duct bifurcation, along with the extrahepatic ducts and/or the intrahepatic ducts, were felt to be the areas most severely affected. This predilection for severe obstructive disease at the hepatic duct bifurcation in sclerosing cholangitis held for both patients with and without inflammatory bowel disease. Thus, most patients with sclerosing cholangitis have cholangiographic evidence of diffuse extrahepatic and intrahepatic biliary tract disease, with the hepatic duct bifurcation being the area generally most severely affected.
回顾了36例硬化性胆管炎患者的胆管造影。患者组的平均年龄为43岁，平均病程为4.5年。其中17例患者合并有炎症性肠病。平均血清胆红素为6.8mg/dl，平均谷草转氨酶为105IU/L，平均谷丙转氨酶为108IU/L，平均血清碱性磷酸酶为534IU/L。胆管造影显示33例患者肝外胆管受累，33例患者肝门胆管分叉受累，35例患者肝内胆管受累。根据最严重梗阻受累区域对胆管造影进行分级。24例患者最严重受累区域为肝门胆管分叉。另外8例患者，肝门胆管分叉连同肝外胆管和/或肝内胆管被认为是受影响最严重的区域。硬化性胆管炎患者肝门胆管分叉处对严重梗阻性疾病的这种偏好，无论有无炎症性肠病的患者均存在。因此，大多数硬化性胆管炎患者有胆管造影证据显示肝外和肝内胆管弥漫性疾病，肝门胆管分叉通常是受影响最严重的区域。
