Fujii H, Yang Y, Matsumoto Y, Suda K
Department of Surgery, Yamanashi Medical University.
Hepatogastroenterology. 1997 Mar-Apr;44(14):328-41.
BACKGROUND/AIMS: In patients with primary intrahepatic bile duct stones, strictures of the biliary duct are often present, but the relationship between these strictures and the formation of the stones remains controversial. Intrahepatic bile duct carcinoma in association with intrahepatic bile duct stones has recently been reported. The present study attempted to ascertain whether bile stasis induced by congenital biliary strictures is the basis for the formation of stones and occurrence of carcinoma.
We analyzed the location of strictures in 58 patients with strictures in the upper portion of the biliary tract including 38 patients with intrahepatic bile duct stones and 9 with intrahepatic bile duct carcinoma. The cell cycle of epithelial cells from the intrahepatic bile duct were analyzed with using proliferating cell nuclear antigen, which is a immunohistochemical staining method.
Fifty six of 58 patients had congenital cystic dilatation of the common bile duct (two infant type and 54 adult type). Thirty eight patients had intrahepatic bile duct stones proximal to the strictures at the hepatic hilum. The location of the strictures were classified into four types. Nine patients had intrahepatic bile duct carcinoma and eight of the 9 carcinomas coexisted with intrahepatic bile duct stones. In the nine patients with intrahepatic bile duct carcinoma, the expression of proliferating cellular nuclear antigen (PCNA) in the carcinoma and the normal bile duct epithelium adjacent to the carcinoma was higher than that of patients with hepatocellular carcinoma without anomaly of the biliary duct.
Considering the location of the strictures and clinical features, the strictures may have been formed congenitally. Furthermore, adult type cysts of the common bile duct with strictures in the upper portion of the biliary tract are thought to be the basis for the formation of primary intrahepatic bile duct stones. The most appropriate treatment for intrahepatic bile duct stones is thus suggested to be removal of the affected hepatic segment including the region of strictures, combined eventually with hepaticoenterostomy.
背景/目的：在原发性肝内胆管结石患者中，胆管狭窄常常存在，但这些狭窄与结石形成之间的关系仍存在争议。最近有报道称肝内胆管癌与肝内胆管结石有关。本研究试图确定先天性胆管狭窄引起的胆汁淤积是否是结石形成和癌症发生的基础。
我们分析了58例胆道上段狭窄患者的狭窄部位，其中38例患有肝内胆管结石，9例患有肝内胆管癌。采用增殖细胞核抗原免疫组化染色法分析肝内胆管上皮细胞的细胞周期。
58例患者中有56例存在先天性胆总管囊肿（2例婴儿型和54例成人型）。38例患者在肝门部狭窄近端有肝内胆管结石。狭窄部位分为四种类型。9例患者患有肝内胆管癌，其中8例癌与肝内胆管结石共存。在9例肝内胆管癌患者中，癌组织及癌旁正常胆管上皮中增殖细胞核抗原（PCNA）的表达高于无胆管异常的肝细胞癌患者。
考虑到狭窄的部位和临床特征，这些狭窄可能是先天性形成的。此外，胆道上段有狭窄的成人型胆总管囊肿被认为是原发性肝内胆管结石形成的基础。因此，对于肝内胆管结石，最合适的治疗方法建议是切除包括狭窄区域在内的受累肝段，并最终结合肝肠吻合术。
