Bernhoft R A, Pellegrini C A, Motson R W, Way L W
Am J Surg. 1984 Jul;148(1):77-85. doi: 10.1016/0002-9610(84)90292-7.
No systematic study of the composition of common duct stones has been carried out to date. In this study, we assessed the chemical composition and morphologic characteristics of common duct stones from 115 patients, and compared them with gallbladder stones in 67 patients who had both. Visually and chemically, common duct stones could be divided into two groups: cholesterol stones and pigment stones. Cholesterol common duct stones contained 83 +/- 1 percent cholesterol, 2.3 +/- 0.4 percent bilirubin, and 5.5 +/- 1 percent insoluble pigment residue. Pigment common duct stones contained 7 +/- 1 percent cholesterol, 24 +/- 2 percent bilirubin, and 38 +/- 3 percent pigment residue. There were two subgroups of pigment stones: one with large amounts of bilirubin and one with large amounts of pigment residue. A high proportion (46 percent) of common duct stones were composed of pigment. Patients with pigment common duct stones were more likely to have cholangitis and pancreatitis than were patients with cholesterol stones. It was not possible to distinguish primary from secondary stones on morphologic grounds. In 65 of 67 patients (97 percent), gallbladder stones and common duct stones were of the same chemical type. Morphologically, cholesterol common duct stones were very similar (3.6+ on a scale of 0 to 4+) to their counterparts. Pigment common duct stones and gallbladder stones were less similar (2.4+). Chemically, cholesterol common duct stones were identical to their gallbladder counterparts. Pigment common duct stones regularly contained a greater fraction of bilirubin and less pigment residue than associated gallbladder stones (p less than 0.05). Earthy common duct stones were associated with earthy gallbladder stones, and were chemically indistinguishable from other pigment stones. These data suggest that all cholesterol common duct stones, and when the gallbladder is present, most pigment common duct stones, are secondary. The latter stones, however, probably grow after entering the duct, adding pigment with a high proportion of bilirubin relative to pigment residue.
迄今为止，尚未对胆总管结石的成分进行系统研究。在本研究中，我们评估了115例患者胆总管结石的化学成分和形态特征，并将其与67例同时患有胆囊结石和胆总管结石患者的胆囊结石进行比较。从外观和化学性质上看，胆总管结石可分为两组：胆固醇结石和色素结石。胆固醇性胆总管结石含胆固醇83±1%、胆红素2.3±0.4%、不溶性色素残渣5.5±1%。色素性胆总管结石含胆固醇7±1%、胆红素24±2%、色素残渣38±3%。色素结石有两个亚组：一个含大量胆红素，另一个含大量色素残渣。胆总管结石中色素结石所占比例较高（46%）。与胆固醇结石患者相比，色素性胆总管结石患者更易发生胆管炎和胰腺炎。从形态学上无法区分原发性结石和继发性结石。67例患者中有65例（97%）胆囊结石和胆总管结石化学类型相同。形态学上，胆固醇性胆总管结石与其对应的胆囊结石非常相似（0至4+分级中为3.6+）。色素性胆总管结石与胆囊结石的相似性较低（2.4+）。化学性质上，胆固醇性胆总管结石与其对应的胆囊结石相同。色素性胆总管结石中胆红素的比例通常高于相关胆囊结石，色素残渣比例低于相关胆囊结石（p<0.05）。土样胆总管结石与土样胆囊结石相关，在化学性质上与其他色素结石无法区分。这些数据表明，所有胆固醇性胆总管结石，以及存在胆囊时的大多数色素性胆总管结石，都是继发性的。然而，后一种结石可能在进入胆管后生长，添加了胆红素比例相对于色素残渣较高的色素。
