Laparoscopic study of cholestatic jaundice Particularly in regard to differential diagnosis between intrahepatic and extrahepatic cholestasis
胆汁うっ滞性黄疸の腹腔鏡的検討

Hajime Kuroda
1983 Journal of Nippon Medical School  
A laparoscopic examination was held in order to consider the differences between intrahepatic and extrahepatic cholestasis. The subjects included 32 cases of acute intrahepatic cholestasis (20 viral and 12 drug-induced cases) and 38 cases of extrahepatic cholestasis (13 stone and 25 cancer cases) to make a total of 70 subjects. Cholestasis was classified into 4 types based on the patterns of the patchy green colorations on the surface of the liver. In Type I , the patchy green colorations were
more » ... elatively circular and uniform and distributed in a regular mesh-like pattern. In Type Ila, adjacent patchy green colorations tended to join together to form varying types of polygons and were distributed in an irregular mesh-like pattern. In Type IIb, the joining of adjacent patchy green colorations was even more marked and the surface resembled a map-like or a brindled pattern. In Type III, no reddish areas remained on the surface of the liver, and the entire surface of the liver was colored green. Type I was intrahepatic and Type III was extrahepatic cholestasis, but it was necessary to discriminate intrahepatic from extrahepatic cholestasis in both Types II a and II b. The dilatation of the bile ductules and lymph vessels as well as micro-abscesses and hepatic matastasis of cancer on the surface of the liver were characteristic findings of extrahepatic cholestasis and were seen in 29 out of 38 cases (76.3%). These findings were discovered in 61.5% of the stone group and 84.0% of the cancer group. Relaxation of the gallbladder was found in 56.3% of the intrahepatic cases, 57.1% of the cases with the obstruction at the hepatic hilum or the common hepatic duct and 50.0% of those with the obstruction at the junction of cystic duct, but not in those with the obstruction at the common bile duct or at the Papilla of Vater. Distension of the gallbladder was evident in 50.0% of the cases with the obstruction at the junction of the cystic duct and 76.2% of those with obstruction at the common bile duct or at the Papilla of Vater, but not in the cases with intrahepatic cholestasis or in those with the obstruction at the high biliary duct. Laparoscopic diagnosis of cholestasis was possible in 68.8% of the intrahepatic cases and 92.1% of the extrahepatic cases. However, the diagnosis rate of Type Ila at 54.2% and Type II b at 66.7% was lower when compared with Type I and Type III. From these results, differential diagnosis of cholestasis was possible in 57 cases (81.4%) out of 70.
doi:10.1272/jnms1923.50.222 pmid:6223046 fatcat:jvmh5mfuujg2tfcvsipkub5qha