Abstract
In order to clarify the pathophysiological findings of papillary function in cases of intrahepatic gallstones and extract their therapeutic implications, constituent classification of the intrahepatic gallstones collected during the past 10 years was carried out: group A consisting of type I calcium bilirubinate gallstones (8 cases); group B of type I E (15); group C of type I E, I E calcium bilirubinate gallstones (10) and group D of cholesterol stones and black stones (6).
Results in the cases of intrahepatic calcium bilirubinate gallstones indicated that contribution of bile stasis due to duodenal papillitis was probable to their stone formation, irrespective of their clinical patterns. In spite of their apparent complete lithotomy, adequate biliary drainage appeared indispensable in many cases. The sphincteroplasty seemed to be one of the most physiological drainage, but it must not be attempted on those patients in whom residual gallstones are probable. No doubt hepatectomy is one of the most reliable and plausible principles of complete lithotomy. In cases of bilateral intrahepatic gallstones, however, first we have to clear the stones in one lobe by PTCS, and then proceed to hepatectomy in the other.
