総胆管結石症の外科的治療

Surgical Treatment of Choledocholithiasis

　総胆管結石症の治療について主として外科的立場から稿を求められたが，結石の種類によってその対処の仕方がかなり異なることをまず強調しなければならない．周知のごとく胆石は主としてコレステロール系石（純コレステロール石，混成石，混合石，以下コ系石と略称）とビリルビン石灰石（以下ビ石）とにおよそ2大別され，その生成機転，臨床症状など相互に全く異なるからである．以下総胆管結石についてもかかる観点から考察を進めてみよう．

　Attention should be given to the fact that in the surgical treatment of choledocholithiasis, the measures to cope with it natually differ according to the type of calculi involved. In the case of calculi such as solitary pure cholesterol and combination stones, the calculi is pushed into the common bile duct due to cholecystitis which frequently accompanies it and forms the so-called confluence stone. In these cases, a complicated and difficult operation becomes necessary. And in the case of numerous mixed stones, there are instances wherein the biliary drainage of the transduodenal sphincteroplasty (TSP) is needed from the point of preferably preventing postoperative remnants. For calcium bilirubinate stones, because important factors in its formation are stagnation and infection of the bile duct rather than in the gallbladder, biliary drainage procedure becomes absolutely necessary for lithotomy. As the background and origin of the calcium bilirubinate stones, a clinical study of prirmary choledocholithiasis is included.