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

肝胆管结石形成中的生物力学机制

曲    凯，刘    昌   

  1. 西安交通大学第二附属医院肝胆胰与移植外科       外科重症与生命支持教育部重点实验室，陕西西安710061
  • 出版日期:2024-03-01

  • Online:2024-03-01

摘要： 我国肝胆管结石发病率高、治疗困难、复发率高、无根治性治疗方法，是目前肝胆外科面临的难题之一。既往对于肝胆管结石的形成主要关注其病因，忽略了生物力学在其中发挥的作用。胆道系统的力学性能与其生理病理功能密切相关。从力学角度看，胆道系统是一个“泵管结构”，肝细胞是胆汁成分的合成源头，通过毛细胆管的机械渗透作用形成胆管胆汁，在胆管中流动并排入肠道，其中胆囊作为泵提供驱动力，Oddi括约肌发挥阀门作用。“泵管结构”的稳定与否，直接关系到胆汁的流动是否顺畅，进而影响肝胆管结石的形成。通过明确胆道系统力学特性与肝胆管结石形成之间的关系，不仅能更深入地理解肝胆管结石的形成原因，而且还能为未来的治疗方法提供新的思路。通过调整胆道系统的力学性能，或许能够从根本上防止肝胆管结石的形成，从而为肝胆管结石的治疗开辟全新的道路。

关键词: 胆管结石, 流体力学, 固体力学, 胆汁淤积, 力学模拟

Abstract: The biomechanical mechanisms in the formation of hepatic bile duct stones        QU Kai, LIU Chang. Department of Hepatobiliary Surgery and Liver Transplantation, the Second Affiliated Hospital of Xi’an Jiaotong University，Key Laboratory of Surgical Critical Care and Life Support (Xi’an Jiaotong University), Ministry of Education, Xi’an 710061, China
Corresponding author：LIU Chang,E-mail:liuchangdoctor@163.com
Abstract    Hepatobiliary stones are one of the most difficult problems facing hepatobiliary surgery in China with high incidence, difficulty treatment, high recurrence rate, and lack of curative treatment method. Previous studies on the formation of hepatobiliary stones have mainly focused on their etiological factors, ignoring the role of biomechanics in the process. However, the mechanical properties of the biliary system are closely related to its physiopathologic functions. From the mechanical point of view, the biliary system is a "pump-tube structure", in which the hepatocyte is the source of bile synthesis, and bile is formed through mechanical osmosis of the capillary bile ducts, then flows through the bile ducts and is discharged into the intestines, with the gallbladder acting as a pump to provide the driving force, and the sphincter of Oddi acting as a valve. The stability of the "pump-tube structure" directly impacts the patency of the bile flow, thereby influencing the formation of hepatobiliary duct stones. Clarifuying the relationship between the mechanical properties of the biliary system and the formation of hepatobiliary duct stones, we can not only gain a deeper understanding of the causes of stone formation but also provide new ideas for future treatment methods. By adjusting the mechanical properties of the biliary system, we may be able to fundamentally prevent the formation of hepatobiliary duct stones, thus paving a new path for the treatment of hepatobiliary duct stones.

Key words: biliary stones, fluid dynamics, mechanical stress, cholestasis, mechanical simulation