肝内胆管结石并局部胆管炎症改变42例胆道镜和病理分析

The choledochoscopy and pathological change of 42 cases of hepatolithiasis with local cholangitis

目的探讨肝内胆管结石并局部胆管炎改变的胆道镜和病理改变及临床意义。方法2002年1月～2007年4月间肝内胆管结石经胆道镜检查确诊局部胆管炎改变42例,将同期入院的38例胆总管结石并胆管炎患者作为对照组,分析其临床表现、实验室检查、胆道镜下观察和病理改变。结果肝内胆管结石并局部胆管炎症组与对照组在年龄组成、性别比例和围手术期谷草转氨酶(AST)、谷丙转氨酶(ALT)两者差别无统计学意义,但其在右上腹痛和黄疸者比例以及术后总胆红素(TB)水平及直接胆红素(DB)水平均低于对照组(P<0.05)。局部胆管炎改变表现为I～V型病理改变。结论在肝内胆管结石病中,存在局部胆管炎改变,并随炎症浸润加深致肝局部纤维化胆管狭窄,引起肝内胆管结石的发生和复发。控制局部胆管炎症,在其限于黏膜层时,可避免胆管炎进一步发展致引起胆管狭窄,则可能预防肝内胆管结石的发生和复发,从而提高肝内胆管结石的远期治疗效果。

Objective To discusss the choledochoscopy and pathological change and of clinical significance of local cholangitis of intrahepatic lithiasis. Methods 42 cases of local cholangitis of intrahepatic lithiasis hospitalized during January 2002 to April 2007 were retrospectically studied .38 cases of exhepatic lithiasis with common bile duct cholangitis incharged in the same period were set as controll group. They were anal-ysed by clinical symptom and labouratory tests and choledochoscopy check-up and pathological change. Results No significant difference were found between age, gender and all round operation period aspartate aminotransferase（AST）,alanine aminotransferase（ALT） during operation period. The local cholangitis group had lower rate of up right quandrant pain and jaundice. The local cholangitis group had lower TB and DB of post operatiton than the common bile duct cholangitis group （P〈0.05）. The local cholangitis represent I-V pathological change. Conclusion Local cholangitis exists in the intrahepatic lithiasis, the inflammation of the membrane and the hyperplasia of the wall of the billiary tract may have caused billiary tract bile straitness ,it can cause the occurrence and reoccurrence of the intrahepatic lithiasis Early therapy through operation and/or choledochoscopy will increase the effect of curing intrahepatic lithiasis and reduce the recurrence.