Jiang C F, Wu C S, Tan S W, Ng K W
Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1993 Jan;51(1):33-9.
Ninety-seven hepatolithiasis cases were reviewed retrospectively. Primary hepatolithiasis was about equal in both sexes, with most patients under 39 years of age. Most secondary hepatolithiasis patients who were female-predominant, were older than 40. Common presenting symptoms were abdominal pain, either epigastric or right upper quadrant of abdomen as noted in 93%; chills and fever in 70%; nausea and vomiting in 49.5%; jaundice was noted only in 39% of the patients. Blood tests showed elevation of alkaline phosphatase in 79.8%, and gamma-GT in 88.3%. Left branch involvement was much more common that right. Escherichia coli (E. coli) was the main organism isolated in most of the cases. Abdominal ultrasonography reached a diagnostic rate of 91.01%, and the condition could be missed in cases of intrahepatic muddy stones, pneumobilia and misidentification of the location of the stones. Endoscopic retrograde cholangiography (ERC) showed a clearer picture of the biliary tree, but failed in cases of distorted anatomy because of previous operation, stones impacted in the ampulla orifice, presence of diverticulum or poor opacification of the bile duct because of stricture or stone impaction.
对97例肝内胆管结石病例进行回顾性分析。原发性肝内胆管结石在男女两性中发病率大致相等，大多数患者年龄在39岁以下。大多数继发性肝内胆管结石以女性为主，年龄在40岁以上。常见的临床表现为腹痛，93%的患者表现为上腹部或右上腹疼痛；70%的患者有寒战和发热；49.5%的患者有恶心和呕吐；只有39%的患者出现黄疸。血液检查显示79.8%的患者碱性磷酸酶升高，88.3%的患者γ-谷氨酰转移酶升高。左肝管受累比右肝管更常见。大多数病例中分离出的主要病原体是大肠杆菌。腹部超声检查的诊断率为91.01%，对于肝内泥沙样结石、胆道积气和结石位置误判的病例可能会漏诊。内镜逆行胆管造影（ERC）能更清晰地显示胆管树，但对于因既往手术导致解剖结构扭曲、结石嵌顿于壶腹开口、存在憩室或因胆管狭窄或结石嵌顿导致胆管显影不佳的病例则无法进行。
