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

复杂肝内胆管结石的诊断与处理

王    坚   

  1. 上海交通大学医学院附属仁济医院胆胰外科，上海200127
  • 出版日期:2016-03-01 发布日期:2016-03-01

  • Online:2016-03-01 Published:2016-03-01

摘要：

复杂肝内胆管结石是指在治疗上不容易达到“祛除病灶，取尽结石，矫正狭窄，通畅引流，防治复发”20字标准的肝内胆管结石，涉及到解剖复杂性、病理生理复杂性、结石分布的广泛性与结石位置特殊性。运用精准外科理念，通过术前精准评估肝功能、结石分布范围、肝脏萎缩和胆道狭窄状况，制定合理的手术规划；术中综合应用围肝门外科技术、胆道镜技术、解剖性肝切除技术和黏膜对黏膜的胆肠吻合技术，以达到降低残石率和复发率的目标。对于门静脉高压伴肝功能不全的肝内胆管结石应兼顾取尽结石与保证手术安全之间的平衡。肝移植是终末期肝内胆管结石的惟一安全有效治疗手段。

关键词: 肝内胆管结石, 精准外科, 围肝门技术, 解剖性肝切除, 胆道镜

Abstract:

Diagnosis and treatment of complicated intrahepatic bile duct stones        WANG Jian. Department of Biliary-pancreatic Surgery, Renji Hospital of Shanghai Jiao Tong University School of Medicine,Shanghai200127,China
Abstract    Complicated intrahepatic bile duct stone is defined as not easy to achieve the treatment standard of lesion eliminating，total stone clearance，stricture removal，unobstructed drainage and recurrence preventing，which related to complexity of anatomy，complexity of pathophysiology，extensiveness of stone distribution and particularity of stone location. The treatment goal is to reduce the residual stone rate and recurrence rate by using precise surgery concept via accurate preoperative assessment of liver function，liver atrophy and stone distribution to develop a reasonable surgical planning，and intraoperative comprehensive application of perihilar surgical techniques，choledochoscope techniques，anatomical liver resection techniques and mucosa-to-mucosa cholangioenterostomy techniques. The treatment principle of intrahepatic bile duct stone combined with portal hypertension and liver dysfunction should meet the balance between the total stone clearance and the guarantee of surgical safety. Liver transplantation is the only safe and effective treatment for end-stage hepatolithiasis.

Key words: intrahepatic bile duct stone, precise surgery, perihilar surgical techniques, anatomical liver resection, choledochoscope