中国实用外科杂志 ›› 2009, Vol. 29 ›› Issue (07): 549-551.

• 专题笔谈 • 上一篇    下一篇

合并胆汁性肝硬化胆管结石的处理

  

  1. 第三军医大学西南医院全军肝胆外科研究所,重庆400038
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2009-07-08 发布日期:2009-07-08

  • Received:1900-01-01 Revised:1900-01-01 Online:2009-07-08 Published:2009-07-08

摘要:

如何选择合并胆汁性肝硬化胆石症病人的手术时机,对于外科医生通常是很棘手的问题。了解其病理及临床特征,进行胆道造影检查,如内镜逆行胰胆管造影、磁共振胰胆管成像,有助于诊断及选择最佳手术治疗方案。祛除病灶、纠正胆管狭窄是治疗该病的原则,而对于复杂肝胆管结石,应考虑采用分期手术治疗,一期接受胆道引流或(和)脾切除门奇断流、门体分流等手术,半年后再行二期胆道手术。内镜技术能有效地处理残余结石或复发。

关键词: 肝胆管结石, 胆汁性肝硬化

Abstract:

Treatment of cholelithiasis associated with biliary cirrhosis BIE Ping,HE Yu. Institute of Hepatobiliary Surgery & Southwest Hospital, the Third Military Medical University, Chongqing 400038, China Corresponding author: BIE Ping, E-mail: bieping@medmail.com.cn Abstract Facing cholelithiasis associated with biliary cirrhosis,surgeons are usually difficult to choose operation opportunity and operation. It is very important to understand pathology and clinical features of the disease. Cholangiography technique such as ERCP,MRCP are helpful for diagnosis.Thus,we could choose optimal surgical treatment. The therapeutic aims are to relive biliary duct obstruction and remove focus.Single radical operations could be performed in most of the patients with hepatolithiasis complicated with biliary cirrhosi,moreover, the biliary cirrhosis could be reversed.It is sensible to perform stage-seperated operations such as splenectomy and portacaval shunt for complicated cholelithiasis, patients could be performed biliary operation after 6 months. Endoscopic intervention is effective in the treatment of biliary cirrhosis in secondary of cholelithiasis.

Key words: hepatolithiasis, biliary cirrhosis