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Intrahepatische Gallengangsteine und Gallengangmissbildungen

Intrahepatic choleductolithiasis and bile duct malformations

Der Gastroenterologe volume 3, pages 14–21 (2008)Cite this article

Zusammenfassung

Bei rezidivierenden Cholangitiden sollten intrahepatische Gallengangsteine differenzialdiagnostisch berücksichtigt werden. Ein intrahepatisches Gallengangsteinleiden ist mit einem deutlich erhöhten Risiko für die Entwicklung eines cholangiozellulären Karzinoms vergesellschaftet. Mit Ultraschall, CT und MRT allein können Cholangiokarzinome bei Patienten mit intrahepatischen Gallengangsteinen häufig nur schwer von einer peribiliären Entzündung unterschieden werden. Primäres Therapieziel bei intrahepatischen Gallengangsteinen ist die Elimination von Cholangitisschüben, die Beseitigung von Galleabflussstörungen und die Vermeidung der Entwicklung einer sekundär biliären Zirrhose und eines Cholangiokarzinoms. Abhängig von Ausdehnung und Befallsmuster kommen interventionell-endoskopische oder chirurgische Verfahren zum Einsatz, adjuvante medikamentöse Ansätze zur Rezidivprophylaxe befinden sich in der Entwicklung. Bei Gallengangmissbildungen (z. B. bilobäre Caroli-Erkrankung, Caroli-Syndrom) sollte frühzeitig eine Lebertransplantation angestrebt werden.

Abstract

In cases of recurrent cholangitis, hepatolithiasis should be considered in the differential diagnosis. Intrahepatic bile duct stones are associated with a significantly elevated risk for the development of cholangiocarcinoma. In cases of hepatolithiasis a differential diagnosis between cholangiocarcinoma and peribiliary inflammation may be difficult by ultrasound, CT or MRI imaging alone. The primary therapeutic goal in patients with hepatolithiasis is the elimination of cholangitis and bile stasis and avoidance of the development of secondary biliary cirrhosis or cholangiocarcinoma. Dependent on localization and extent of hepatolithiasis, interventional endoscopic as well as surgical therapeutic strategies may be chosen. Adjuvant pharmacologic prevention of recurrence of bile duct stones is under development. In cases of bile duct malformations, such as bilobar Caroli’s disease or Caroli’s syndrome, liver transplantation should be considered at an early stage. An interdisciplinary approach is of vital importance.

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Authors and Affiliations

  1. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    H. Schrem, H. Bektas & J. Klempnauer

  2. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland

    J. Wedemeyer & M.P. Manns

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  1. H. Schrem
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Correspondence to H. Schrem.

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Schrem, H., Wedemeyer, J., Bektas, H. et al. Intrahepatische Gallengangsteine und Gallengangmissbildungen. Gastroenterologe 3, 14–21 (2008). https://doi.org/10.1007/s11377-007-0139-9

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