关键词: 肝胆管结石, 肝切除, 胆肠吻合, 经皮经肝胆道镜

Abstract:

Difficulties，misunderstandings and countermeasures in the treatment of hepatolithiasis        LIANG Li-jian. Department of Hepatic and Biliary-Pancreatic Surgery，the First Affiliated Hospital of Sun Yat-Sun University, Guangzhou 510080，China
Abstract    Although the morbidity of hepatolithiasis is decreased，it is not a disapearing disease. Hepatolithiasis often complicates with bile duct stenosis，recurrent cholangitis，and it would develop to liver cirrhosis and portal vein hypertension in its advanced period. Moreover，it is an important factor for cholangiocarcinoma. It is difficult to diagnose and treat hepatolithiasis，which has great harm to patients’ health. Anatomic hepatectomy is the preferred treatment for hepatolithiasis；bilateral lesions resection should be proceeded for the cases of bilateral lesions. A detailed treatment plan should be made based on comprehensive imaging examinations，especially a real reconstruction of three-dimensional visualization image model based on CT or MR images. Hepaticojejunostomy as adjuvant therapy should be proceeded with strictly indications and appropriate anastomosis. Percutaneous transhepatic cholangioscopy provides a new choice for patients who were inoperable hepatectomy，residues and/or recurrent stones after multiple surgeries or complicated  cirrhosis.

Key words: hepatolithiasis, hepatectomy, hepaticojejunostomy, percutaneous transhepatic cholangioscopy