摘要
肝胆管结石合并胆道感染是胆道外科的常见病,但如何合理、规范、彻底的治疗却是难题。须根据病人的临床表现,实验室检查和影像学检查做出临床诊断,准确评估病情,选择合适的治疗方案。肝胆管结石合并胆道感染,须在炎症完全控制后再实施确定性手术治疗。轻度急性胆管炎抗感染治疗可缓解症状,待炎症控制后进行确定性手术。中度急性胆管炎可先予以保守治疗,严密观察病情变化,如有加重,及时行胆道减压引流。重度急性胆管炎需尽早行胆管减压引流。胆道引流可选择内镜下引流、经皮经肝胆管引流(PTBD)或手术引流,待炎症完全控制后进行彻底性手术治疗。确定性手术治疗方式可选择肝段/肝叶切除,同时整复狭窄的胆管行胆道重建,必要时尚须行胆肠吻合。对合并慢性胆道感染,在取净肝内胆管结石需同时切除病变的肝组织。
Hepatolithiasis combined with biliary infection is a common disease of biliary surgery. However, the reasonable, standardized, completely treatment is still a problem. Surgeons should make clinical diagnosis according to clinical manifestations, laboratory tests and imaging examinations, assess the severity of the disease accurately and perform appropriate treatment plan. For mild acute cholangitis, anti-infection and supporting treatment is often effective, and operation should be done later when the inflammation was controlled. Moderate acute cholangitis may receive conservative treatment firstly under strict observation, and biliary decompression should be performed immediately when the condition deterioraed. However, for severe acute cholangitis, anti-infective and support treatment is usually ineffective, and decompression and drainage of biliary duct should be performed as soon as possible. The bile drainage methods include endoscopic drainage, PTBD, and surgery. The complete operation should be performed when the biliary inflammation has been controlled. Operation methods include resection of liver segment/lobe, plastic operation of the stricture and reconstruction of bile duct. For chronic biliary infection, besides complete operation of biliary stones, the liver lesion should be resected at the same time.
出处
《中国实用外科杂志》
CSCD
北大核心
2016年第3期295-299,共5页
Chinese Journal of Practical Surgery
关键词
肝胆管结石病
胆道感染
胆管减压
肝切除
hepatolithiasis
biliary infection
biliarydecompression
hepatectomy
作者简介
通信作者：曾永毅，E—mail：1amp1973@medmail．com．cn
