Nichols D M, Macleod A J
Department of Radiology, Raigmore Hospital, Inverness, UK.
Clin Radiol. 1998 Jan;53(1):49-52. doi: 10.1016/s0009-9260(98)80034-2.
Distal bile duct stones and proximal extra-hepatic malignant biliary obstructions may coexist. These stones, probably predating the development of the malignant obstruction but of unknown aetiological significance, were found in seven of 60 patients with proximal tumours (11.6%) at percutaneous biliary drainage. In two of these cases, stones blocked outflow from a supra-ampullary stent. All seven patients also had evidence of gall-bladder stones. Five of the seven patients had cholangiocarcinoma, giving an incidence of duct stones in such patients (n = 27) of 18.5%. In one case, the stones were removed endoscopically, in four, the stones were removed percutaneously and, in the remaining two cases, they were left in situ beside a stent. None of 120 cases with malignant obstruction had stones proximal to the obstruction. Distal common duct stones are associated with proximal malignant biliary duct obstruction, especially with cholangiocarcinoma and coexisting gall-bladder stones. They may interfere with stent function and cause diagnostic confusion at cholangiography.
远端胆管结石与近端肝外恶性胆管梗阻可能并存。这些结石可能在恶性梗阻发生之前就已存在，但病因不明，在60例近端肿瘤患者中的7例（11.6%）经皮胆道引流时发现了这些结石。在其中2例中，结石阻塞了壶腹上支架的流出道。所有7例患者也有胆囊结石的证据。7例患者中有5例患有胆管癌，此类患者（n = 27）中胆管结石的发生率为18.5%。1例患者通过内镜取出结石，4例经皮取出结石，其余2例结石留在支架旁原位。120例恶性梗阻患者中，梗阻近端均无结石。远端胆总管结石与近端恶性胆管梗阻相关，尤其是与胆管癌和并存的胆囊结石相关。它们可能干扰支架功能，并在胆管造影时造成诊断混淆。
