摘要
肝内胆管结石病仍是肝胆外科面临的重要课题。其发病机制尚未完全阐明,但多数学者认为与细菌感染引起的游离胆红素过多有关。长期反复的肝内胆管结石可发展为胆汁性肝硬化,且与胆管癌的发生相关。经过半个多世纪的探索及临床研究,形成了治疗肝内胆管结石的五大原则,即取尽结石、清除病灶、纠正狭窄、通畅引流、预设通道。基于保留Oddis括约肌和正常胃肠解剖的理念,我院全军外科中心设计和应用皮下通道型胆囊肝胆管成型术治疗肝内胆管结石,并取得了良好疗效。由于胆汁酸可溶解游离胆红素和钙,因此术后提高肝内胆汁酸浓度对预防结石复发具有重要作用。
Without explicit explanation of pathogenesis, the treatment of hepatolithiasis remains a great challenge to hepatobiliary surgeons. It is widely recognized that bacterial infection plays a critical role in the formation of bilirubin calculus, and the main component of intrahepatic stones. Repeated recurrences of bepatolitbiasis due to inappropriate treatment prompt the development of biliary cirrhosis, and it is associated with cholangiocarcinoma. After a long-time exploration and clinical investigation, the surgery principles for hepatolithiasis are proposed as clearing stones, eliminating focus of infection, rectifying stricture, smoothing drainage and laying passage. On the basis of the conception that oddis sphincter and normal gastroenterologic anatomy should be re- served, we have designed and performed hepatocholangioplasty with subcutaneous tunnel using gallbladder, and observed a satisfactory outcome of the hepatolithiasis treatment. As the bile acid is important for dissolving unconjugated bilirubin, it would be beneficial for preventing stone recurrence to raise the bile acid concentration post-operation.
出处
《临床误诊误治》
2012年第1期1-4,共4页
Clinical Misdiagnosis & Mistherapy
基金
四川省卫生厅科研项目(110467)
关键词
胆管
肝内
结石
胆管炎
肝硬化
胆汁性
胆管肿瘤
Bile duct, intrahepatic
Calculus
Angiocholitis
Liver cirrhosis, Biliary
Bile duct neoplasm
