Changes of Intrahepatic Ducts Before and After Removal of Intrahepatic Stones

肝內結石症之肝內膽管取石前後之變化

邱文德(Man-Tak Yau) ； 周宗賢(Tsung-Hsien Chou) ； 柯成國(Chen-Guo Ker) ； 陳鴻曜(Hong-Yaw Chen) ； 阮仲洲(Chung-Chou Juan) ； 羅海韻(Hoi-Wan Lo) ； 陳寶輝(Pao-Huei Chen)

《中華放射線醫學雜誌》 26卷6期 (2001/12) Pp. 237-242

摘要

肝內膽管型態與肝內結石形成有相當關係，其肝內膽管擴張或狹窄造成膽汁滯留再形成膽石，然而狹窄或擴張何者事先是無法知曉。
方法: 本研究包括30例肝內結石手術病例，膽管之狹窄或擴張均採左肝管為分析對象，而以相同位置分枝為對照組，其肝內膽管影像均採取1) 經皮穿肝膽道造影，2) 內視鏡逆行性膽胰管造影，或 3) 術後膽道鏡造影而來，從這些影像可計算出膽石取出後之狹窄及擴張肝內膽管之變化。結果：肝內結石之膽管狹窄部份部位與對照膽道分別為5.00 ± 1.93mm及6.50 ± 2.53mm，然而擴張肝內膽管之取石前後則為17.10 ± 5.75mm及14.10 ± 4.70mm，所以取石後擴張膽管是會改善的。再計算擴張部份與狹窄部份比較有肝石膽管取石前後分別為3.35及1.88可見擴張部份大為改善，而且狹窄部位也改善。結論：肝內結石症之膽管狹窄部份可因手術或取石後而改善，擴張部份也會因取石完整及狹窄改善而縮小，但有些病例雖然狹窄部份改善但擴張依然存在。

關鍵字

膽汁滯留 ； 膽管 ； 肝內結石症

並列摘要

The stenosis and/or dilatation of intrahepatic ducts were contributing to the stone formation due to bile stasis. However, the priority of stenosis or dilatation was difficult to decide which one was coming first.
Patients and Methods: Thirty patients of operative intrahepatic stones were encountered in this study. The measurement of left intrahepatic ducts were obtained from the direct cholangiogram including the Percutaneous Transhepatic Cholangiography (PTC), Endoscopic Retrograde Cholangio-pancreatography (ERCP) and post-operative cholangiogram (POC). The diameter of stenotic portion and dilated portion of intrahepatic ducts with stones were measured before and after removing the stones. The control branch without stones was also carried out in right intrahepatic duct of the same level in the same patient. Results: The diameter of the stenotic portion of intrahepatic duct before removing the stones was 5.10 ± 1.93mm and that of the control branches was 6.50 ± 2.53mm (P＞0.05). After removal of the stones, the diameter of stenotic duct were widening to 7.50 ± 2.76mm with a significant difference from that before removing the stones (P＜0.05). The dilated duct was measured about 17.10 ± 5.75mm before removing the stones and became 14.10 ± 4.70mm with a significant change (P＜0.05) after removal of the stones. The ratio of the diameter to stenotic ducts was 3.35 and 1.88mm before and after removal of the stones. Conclusion: After correction of the stenotic portion and complete removal of stones, the dilated duct will improve and become smaller usually. Although the stenotic portion had been improved and stones removed completely, the dilated portion was remained the same in some situations.

並列關鍵字

stenosis of bile duct ； bile duct ； hepatolithiasis