Uno K, Tsuchida Y, Kawarasaki H, Ohmiya H, Honna T
Department of Pediatric Surgery, University of Tokyo, Japan.
J Am Coll Surg. 1996 Dec;183(6):583-8.
Biliary stricture with dilatation is a putative cause of intrahepatic bile duct stones. However, this hypothesis has never been proved.
Fifty-six patients had operative cholangiography, underwent standard excision of a choledochal cyst, and were reviewed at follow-up clinics at a mean follow-up time of 13 years and 6 months. The incidence of complications such as intrahepatic cholelithiasis was analyzed according to the morphologic types of the intrahepatic bile ducts as observed at the initial operation.
Group 1 patients (29 cases) did not show any dilatation of the intrahepatic bile ducts. Intrahepatic cholelithiasis developed in only one case (3 percent). In group 2 (24 cases), the intrahepatic bile ducts were dilated but not associated with any downstream stenosis. One patient (4 percent) suffered from intrahepatic cholelithiasis. Group 3 patients (3 cases) had dilatation of the intrahepatic bile ducts associated with downstream stenosis, and none of them was free from the development of intrahepatic biliary stones (3 cases).
Patients with biliary dilatation with stricture of the intrahepatic bile ducts are most likely to develop intrahepatic cholelithiasis after surgical excision of a choledochal cyst, and their stenosis should be relieved by whatever means feasible at initial operation.
胆管狭窄伴扩张被认为是肝内胆管结石的一个潜在病因。然而，这一假说从未得到证实。
56例患者接受了术中胆管造影，进行了胆总管囊肿标准切除术，并在随访门诊接受复查，平均随访时间为13年6个月。根据初次手术时观察到的肝内胆管形态学类型，分析肝内胆管结石等并发症的发生率。
第1组患者（29例）肝内胆管未显示任何扩张。仅1例（3%）发生肝内胆管结石。第2组（24例）肝内胆管扩张，但无任何下游狭窄。1例患者（4%）患有肝内胆管结石。第3组患者（3例）肝内胆管扩张并伴有下游狭窄，无一例未发生肝内胆管结石（3例）。
肝内胆管狭窄伴扩张的患者在胆总管囊肿手术切除后最有可能发生肝内胆管结石，应在初次手术时采取任何可行的方法解除其狭窄。
