Although the treatment of gallbladder stones is mainly dependent on surgical intervention, recently medical treatmetns such as oral bile acid therapy, dissolution therapy with MTBE or extracorporeal shock wave lithotripy have been also
perforined.
For
the success of these medical therapy, the composition of gallbladder stones is a important factor. So, to predict the chemical composition, we examined 100 cases of the surgically removed gallbladder stoens by ultrasonography. And we compared the
ultrasonographic findings of gallbladder stones with the chemical compositions and the features of cut surface. Also we compared the presence of the calcification on the simple abdommal X-ray. the chemical components of gallbladder stones were
analysed
by ultrated spectrometer. Ultrasonographic findings were classified into five characteristic types; the shooting-star (SS) type, the crescent ( C ) type, the half-moon (HM) type, the full-moon (FM) type and the star-dust (SD) type.
The results were as follows. In chemical compositions of gallstones, 67 cases (67%) were choldesterol stones with 26 cases (26%) of pure cholesterol stones and 30 cases (30%) of cholesterol-bilirubinate stones, bilirubinate stone were 25 cases
(25%),
calcium-carbonate stones were 7 cases (7%), and calcium phosphate stone was 1 case (1%). In ultrasonographic finding of gallstones, the SS types were 24 cases (24%), the C types 43 cases (43%), the FM types 16 cases (16%), the HM types 14 cases
(14%)
and the SD types were 3 cases (3%). In the relationship between ultrasonographic findings and chemical composition, the SS type included cholesterol stones with 21 cases (88%). The C type included cholesterol stones with 30 cases (70%) and
bilirubinate
stones with 13 cases (13%). The HM types included cholestrol stones with 9 cases (64%), bilirubinate stones with 3 cases (24%) and calcium carbonate stones with 2 cases (14%) The FM types included cholesterol stones with 5 cases (31%),
bilirubinate
stones with 6 cases (38%), calcium carbonate stones with 4 cases (25%), and calcium phosphate stone with 1 case (6%). The SD types included cholesterol stone with 2 cases (67%) and bilirubinate stone with 1 case (33%). Cholesterol stone were
found
mainly in the C type (45%) and the SS type (31%). bilirubinate stones were found mainly in the C type (52%) and the FM type (24%). In comparison between the presence of calcification-on the simpole abdominal X ray and the chemical composition
with
ultrasonographic findings, 9 of 100 cases of gallbladder stones showed calcification on the simple abdominal X-ray with 2 cholesterol stones, 5 bilirubinate stones, 2 calcijm carbonate stones. Non cholesterol stoens showed more frequent
calcification
findings than cholesterol stones. In the features of the cut surfaces of the 100 gallbladder stones, the concenteric types were 64 cases (64%), the homogenous types were 26 cases (26%), and the radiating types were 10 cases (10%). And there was
no
correlation between the features of the cutsurfaces of gallbladder stones and the ultrasonographic findings.
In conclusion, the classification of ultrasonographic findings are useful to predict the chemical compositions of gallbladder stones and to decide on the therapeutic method of gallbladder stones.
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