Lakshmi M V, Sridharan G V, Butterworth D
University Department of Geriatric Medicine, Hope Hospital, Salford.
Br J Clin Pract. 1993 May-Jun;47(3):164-5.
Gallstones are common and their incidence increases with age. Fifty per cent of these stones are in the common bile duct (CBD) in the elderly. Most of them are silent but with time there is an increasing chance of developing symptoms which are more likely to be serious in the elderly. Failure to relieve mechanical obstruction of bile flow may lead to secondary biliary cirrhosis. It has been estimated that on average secondary biliary cirrhosis develops some seven years after the onset of obstruction from a stricture, four and half years after gallstone obstruction and 10 months after the onset of malignant stricture. The characteristic features are the pathological findings of portal-portal linkages, with a pattern of monolobular cirrhosis and the preservation of normal vascular relationships. Secondary biliary cirrhosis may lead to hepatic insufficiency and portal hypertension with the resultant complications, such as bleeding oesophageal varices, hypersplenism with pancytopenia, ascites and encephalopathy. We describe a patient in whom the diagnosis was not suspected until laparotomy and confirmed only at autopsy.
胆结石很常见，其发病率随年龄增长而增加。在老年人中，这些结石有50%位于胆总管（CBD）。大多数结石没有症状，但随着时间的推移，出现症状的可能性会增加，而在老年人中症状更可能较为严重。未能解除胆汁流动的机械性梗阻可能会导致继发性胆汁性肝硬化。据估计，平均而言，继发性胆汁性肝硬化在因狭窄导致梗阻开始后约七年出现，胆结石梗阻后四年半出现，恶性狭窄开始后十个月出现。其特征性表现是门静脉 - 门静脉连接的病理发现，呈单小叶肝硬化模式且保留正常血管关系。继发性胆汁性肝硬化可能导致肝功能不全和门静脉高压以及由此产生的并发症，如食管静脉曲张出血、脾功能亢进伴全血细胞减少、腹水和脑病。我们描述了一名患者，直到剖腹手术时才怀疑其诊断，仅在尸检时得以确诊。
