摘要
复杂肝外胆管结石指通过1次手术难以完全达到“取净结石、去除病灶、解除狭窄、通畅引流”肝内胆管结石治疗原则或合并其他肝脏疾病的肝外胆管结石,涉及肝门部胆管结石嵌顿、胆管远端结石嵌顿、Mirizzi综合征、胆囊管残余结石、复发性肝外胆管结石、合并门静脉高压症和合并肝内胆管结石等。通过全面细致术前评估,明确肝外胆管结石病因、结石与胆管狭窄位置、胆管变异、肝十二指肠韧带内解剖、肝脏功能及胆道感染,合理制订手术规划,术中综合应用围肝门外科技术、胰门板降低技术、Oddi括约肌切开成形术以及胆道镜碎石与取石术等,可降低结石残留率和复发率。合理选择内镜逆行胰胆管造影术指征,正确把握胆肠吻合术适应证,可在取净结石前提下防止肝外胆管医源性损伤。
Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance,stricture removal,unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases,which include hepatic hilar bile duct stones incarceration,distal bile duct stone incarceration,Mirizzi syn⁃drome,residual cystic duct stones,recurrent extrahepatic bile duct stones,and combined with portal hypertension or intrahe⁃patic bile duct stones.Through comprehensive and meticulous preoperative evaluation,we can clarify the cause of extrahepatic bile duct stones,the location of stones and bile duct stenosis,the variability of bile duct,the anatomy of the hepatoduodenal ligament,the condition of liver function and biliary tract infec⁃tion,and make the proper surgery plan.During the surgery,we apply the perihilar surgical techniques,pancreatic hilar plate reduction techniques,Oddi sphincter incision and shaping,and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate.It is important that reasonably select endoscopic retrograde cholangiopancreatography indications,correctly hold indications of bilioenteric anastomosis,and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones.
作者
王坚
陈炜
Wang Jian;Chen Wei(Department of Biliary⁃Pancreatic Surgery,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2019年第12期1113-1117,共5页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金面上项目(81472240、81773184)
2016上海领军人才培养计划
上海市科委课题赞助项目(16411952700)
上海申康促进市级医院临床技能与临床创新三年行动计划(16CR2002A、16CR3028A)。
关键词
肝胆管结石病
肝外胆管结石
围肝门外科技术
胰门板降低技术
胆道镜
碎石
Hepatolithiasis
Extrahepatic bileduct stone
Perihilar surgical techniques
Pancreatic hilar plate reduction tech⁃niques
Choledochoscope
Lithotripsy
作者简介
通信作者:王坚,Email:dr_wangjian@126.com。
