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Medical Treatment for Choledocholithiasis M. Miyaji 1 , T. Hayakawa 1 , K. Katagiri 1 , N. Terao 1 , M. Hosino 1 , T. Takeuchi 1 1The First Department of Internal Medicine, Medical School, Nagoya City University pp.633-640
Published Date 1981/6/25
DOI https://doi.org/10.11477/mf.1403108072
  • Abstract
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 Medical management for stones in the common bile duct has been studied in each of the stages when patients had some complaints and when they were free from symptoms, or had silent stones. When there are some symptoms the chief aim of medical treatment is how to cope with concomitant bacterial infection and obstructive jaundice. Bile duct drainage by PTCD or surgery is effective in patients with occlusive jaundice and acute obstructive suppurative cholangitis that show high mortality. After PTCD bacilli in the bile are often positive as the time passes by. Symptoms would often recur by the decreased bile flow caused by bacillary pollution.

 For the individuals that were symptom free or had silent stones we studied stones in the common bile duct by both clinical cases and those of autopsy. Of 1,236 cases autopsied in Nagoya KoseiHospital from March 1961 to December 1980, stones in the common bile duct were seen in 39 (3.3%). Of these, 13 cases (33%) belonged to the silent group. There was no difference between the silent-stone group and the group with some symptoms regarding age, the number of stones and the rate of associated gallbladder stones. However, the biliary duct when alive was far better opacified by excretory cholangiography (oral combined with peroral and intravenous) in the group with no symptoms (45%) than in the group with some symptoms. In clinical cases as well, stones were visualized in all five cases. For individuals with silent stones, surgical operation is indicated generally however, we consider that internal follow-up is possible for the advanced aged who have some basic other diseases and have retired from the active life and whose biliary tract is well opacified by excretory cholangiography.


Copyright © 1981, Igaku-Shoin Ltd. All rights reserved.

基本情報

電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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