中国实用外科杂志

中国实用外科杂志

• 专题笔谈 • 上一篇    下一篇

肝胆管结石合并胆道感染的诊治策略

曾永毅，赖子森   

  1. 福建医科大学孟超肝胆医院肝胆外科，福建福州350025
  • 出版日期:2024-03-01

  • Online:2024-03-01

摘要： 肝胆管结石并发胆道感染是胆道外科常见疾病，发病率逐年上升。因为肝胆管结石的高残余结石率和高复发率、高再手术率，如何早期合理治疗以提高肝胆管结石的治愈率是目前肝胆外科面临的难题之一。须根据病人的全身情况、实验室检查和影像学检查作出诊断，准确评估病情，选择合适的治疗方案。外科手术是肝胆管结石的主要治疗方式。当肝胆管结石合并胆道感染完全控制后须择期行确定性手术治疗。抗感染及胆道引流是急性胆道感染早期治疗手段。其中胆道引流方式主要有内镜下胆道引流、经皮经肝胆道穿刺引流术和外科手术。待炎症完全控制、全身情况好转后实施根治性手术。其中规则性肝段或肝叶切除术可以有效地治疗肝内胆管结石、胆管狭窄及胆管恶变；胆道狭窄修复重建可有效处理肝门部胆管狭窄及胆总管下段狭窄或松弛。微创治疗技术在复杂型肝胆管结石的治疗安全、有效、可行，可显著提高肝内胆管结石的治愈率，具有特定的优势和临床应用价值。

关键词: 肝胆管结石, 胆道感染, 肝切除, 微创技术

Abstract: Diagnosis and treatment strategy for hepatolithiasis combined with biliary infection        ZENG Yong-yi,LAI Zi-sen. Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
Corresponding author: ZENG Yong-yi,E-mail:lamp197311@126.com
Abstract    Hepatolithiasis combined with biliary infection is a common disease in hepatobiliary surgery, with an increasing incidence rate. Due to the high residual stone rate, recurrence rate, and reoperation rate of the disease, how to achieve early and effective treatment to improve the cure rate of hepatolithiasis is one of the challenges faced by hepatobiliary surgeons. Diagnosis should be made based on the patient's overall condition, laboratory tests, and imaging examinations, accurately assess the condition, and choose appropriate treatment options. Surgical intervention is the main treatment method for hepatolithiasis. When the infection in hepatolithiasis combined with biliary infection is completely controlled, definitive surgical treatment should be performed. Antimicrobial therapy and biliary drainage are early treatment methods for acute cholangitis. Biliary drainage methods mainly include endoscopic biliary drainage, percutaneous transhepatic biliary drainage, and surgical intervention. Definitive surgery should be performed after complete control of inflammation and improvement in the patient's overall condition. Hepatic segment/lobe resection is an effective treatment for intrahepatic bile duct stones, biliary strictures, and biliary malignancies. Biliary stricture repair and reconstruction are effective in managing strictures of the hepatic duct at the hepatic hilum or the distal common bile duct. Minimally invasive treatment techniques are safe, effective, and feasible in the treatment of complex intrahepatic bile duct stones, and can significantly improve the cure rate. They have specific advantages and clinical value.

Key words: hepatolithiasis, biliary infection, hepatectomy, minimally invasive techniques