Abstract：
The goal of this study was to determine the prevalence, epidemiology and clinical-therapeutical evolution of hepatolithiasis (HL) in Argentina. With this purpose a survey was conducted sending a questionnaire to ten referencial and interventional radiology centers in the country. Seven centers answered on time. In the last five years a total of 8,736 consecutive patients were examined for cholangiography (endoscopic retrograde cholangiography, PTC). A total of 5,920 (68%) were biliary lithiasis and 53 (0.9%, range 0.5-2.6%) of these were HL. In case of HL the diagnostic procedure was the ERCP in 68% of the cases, and the PTC in the remainder 32%. The patients with HL (53% females, mean age 52, range 23-85) clinically presented cholangitis (79%); pancreatitis (6%) and five (9.4%) showed evolution to a biliary cirrhosis. Associated diseases or abnormalities of the biliary tree were: biliary postsurgical strictures (BPS), 28%; Caroli\'s Syndrome, 20%; and choledocholithiasis, 28%. While a 9.4% presented a \"biliary history\" (that was defined as two or more episodes of biliary surgery) and a 5.7% lacked associated or predisposing diseases. Follow-up was lost in 23% of the cases and in 77% a follow up of 38 months (range 8-60) was observed with 4.8% mortality rate. The treatment was hepatobiliary surgery in 58% of the cases; endoscopic papillotomy in 17% and combined treatments that included extracorporeal shock wave lithotripsy and ursodeoxycholic acid (UDCA) in 15%. Four out of 53 cases (7.5%) received UDCA as the only successful therapy. HL is an entity with high biliary morbidity in 85% of the cases and development in to cirrhosis in 9.4%. When the diagnosis is made in the western world both BPS and Caroli must be discarded first. Combined treatments or only UDCA are new therapeutical alternative in the western world.
摘要：
这项研究的目的是确定患病率，阿根廷肝胆管结石（HL）的流行病学和临床治疗演变。为此目的，进行了一项调查，向该国的十个参考和介入放射学中心发送了问卷。七个中心准时回答。在过去的五年中，共有8,736例连续患者接受了胆道造影检查（内窥镜逆行胆道造影，PTC）。共有5,920例(68%)胆管结石和53例(0.9%,范围0.5-2.6%)其中为HL。对于HL，68%的病例的诊断程序是ERCP，剩下的32%是PTC。HL患者（53%为女性，平均年龄52岁，范围23-85）临床表现为胆管炎（79％）；胰腺炎（6％）和5（9.4％）表现为胆汁性肝硬化。胆道树的相关疾病或异常为：胆道术后狭窄（BPS），28%；卡罗利综合征，20%；和胆总管结石，28%。虽然有9.4％的患者出现“胆道病史”（定义为两次或两次以上的胆道手术发作），但有5.7％的患者缺乏相关或易感疾病。23％的病例随访失败，77％的病例随访38个月（范围8-60），死亡率为4.8％。58％的病例采用肝胆手术治疗；17％的内镜乳头切开术，15％的联合治疗包括体外冲击波碎石术和熊去氧胆酸（UDCA）。53例中有4例（7.5％）接受了UDCA作为唯一成功的治疗。HL是在85％的病例中具有高胆道发病率的实体，在9.4％的病例中发展为肝硬化。在西方世界进行诊断时，必须首先丢弃BPS和Caroli。联合治疗或仅UDCA是西方世界的新治疗选择。
