Abstract：
A 91-year-old man had a history of cholecystectomy and choledochostomy for cholecystolithiasis and choledocholithiasis. Eleven years earlier, intrahepatic stones were found in the posterior bile duct, and he did not wish to undergo treatment. Over time, worsening of the intrahepatic stones and dilation of the intrahepatic bile duct were observed. At 91 years old, enhanced abdominal CT revealed wall thickening of the hilar bile duct, and MRCP showed stenosis of the hilar bile duct. Endoscopic retrograde cholangiography showed no contrast in the right intrahepatic bile duct and marked dilation of the left intrahepatic bile duct. Brush cytology confirmed adenocarcinoma, leading to a diagnosis of hilar cholangiocarcinoma. He underwent open right and caudal lobectomy with biliary reconstruction. Histopathological examination revealed a hilar cholangiocarcinoma, T3N1M0, Stage Ⅲc, mainly located at the confluence of the right and left hepatic ducts. This case suggests a potential association between hepatolithiasis and hilar cholangiocarcinoma, emphasizing the importance of regular imaging examinations for timely surgical resection. Early intervention, including liver resection, is recommended for the management of hepatolithiasis.
摘要：
一名91岁的男子有胆囊结石和胆总管结石的胆囊切除术和胆总管造口术史。11年前,肝内结石被发现在后胆管，他不希望接受治疗。随着时间的推移,观察到肝内结石恶化和肝内胆管扩张。91岁，增强腹部CT显示肝门胆管壁增厚，MRCP显示肝门部胆管狭窄。内镜逆行胆管造影显示右肝内胆管无造影，左肝内胆管明显扩张。刷细胞学证实腺癌，导致肝门部胆管癌的诊断。他接受了开放式右叶和尾叶切除术，并进行了胆道重建。组织病理学检查发现肝门部胆管癌，T3N1M0,Ⅲc期,主要位于左右肝管的汇合处。此病例提示肝胆管结石与肝门部胆管癌之间存在潜在关联,强调定期影像学检查对及时手术切除的重要性。早期干预,包括肝切除术,推荐用于治疗肝胆管结石。
