摘 要 肝膽管結石病原發于左右肝管匯合部以上,雖然目前在上海地區較少,但仍然在國內部分地區較為常見。其診斷包括臨床表現,影像學檢查和實驗室檢查。手術治療是肝膽管結石病的主要治療方法,但有一定的手術指證,不同的手術治療應對不同的適應證以及不同的效果。盡管肝膽管結石病有多種手術治療方法以及非手術治療方法,但總體治療困難,預后較差,有待臨床醫學的深入研究。
關鍵詞 肝膽管結石病 診斷 手術治療 非手術治療
中圖分類號:R657.4 文獻標識碼:C 文章編號:1006-1533(2012)20-0006-04
Diagnosis and treatment of hepatolithiasis
Zheng Ya-xin
(Department of Hepaticobiliary Surgery, Easten Hospital, Shanghai Tongji University, Shanghai 200120, China)
ABSTRACT Hepatolithiasis is formed primarily at bile ducts above the common hepatic duct. Intrahepatic lithiasis is a rare entity in Shanghai but highly prevalent in some province in China. It can be diagnosed with clinical manifestations, imaging examinations and laboratory tests. Operative management is a main method for the treatment of hepatolithiasis. There are several operative therapies with different indications and different results. The majority of patients with hepatolithiasis are difficult to be treated with poor prognosis in spite of some operative and nonoperative therapies. Hepatolithiasis is a real challenge in medicine worldwide.
KEY WORDS hepatolithiasis; diagnosis; surgical management; nonsurgical treatment
肝膽管結石?。╤epatolithiasis)即原發性肝膽管結石(primary intrahepatic stone),通常也稱肝內膽管結石,是原發于左右肝管匯合部以上、位于肝內各分支膽管內的結石,是一種國內部分地區較常見的、治療困難的良性膽道疾病。該病在包括我國在內的東南亞地區高發,而在西方國家發病較少[1]。
肝膽管結石主要為膽紅素結石,膽道感染和膽汁淤積是主要的發病機制[2]。肝膽管結石可呈彌漫性分布,也可局限在一處,一般以左外葉和右后葉多見,這可能與該處膽管彎曲度較大、膽汁易于郁積有關。
1 肝膽管結石的診斷
肝膽管結石的診斷包括臨床表現、影像學及實驗室檢查。
1.1 肝膽管結石的臨床表現
肝膽管結石發病較為隱匿,病程也往往較長,部分患者初次就診時已經為晚期,發生了嚴重的并發癥如膽汁性肝硬化、肝萎縮、門靜脈高壓癥、化膿性膽管炎、甚至惡化成為肝膽管癌[3]。
肝膽管結石病的臨床表現根據病程的長短和病變的輕重各有不同,早期常無明顯的臨床表現,隨著病程的進展,可表現為間歇性的上腹部輕度不適,有時還出現急性膽管炎的癥狀[4]。……