肝胆管结石症取石后胆管壁病变及其转归  

The recover and prognosis of biliary wall lesions after the removal of complex hepatolithiasis

作　　者：戴毅[1] 刘袁君[1] 孟敏 赵剑[1] 葛明刚[1] 王春华[1] 罗丹[1] DAI Yi;LIU Yuan-jun;MENG Min;ZHAO Jian;GE Min-gang;WANG Chun-hua;LUO Dan(Department of Hepatobiliary Surgery,Suining Central Hospital,Suining,Sichuan 629000,China;Department of Oncology,Suining Central Hospital,Suining,Sichuan 629000,China)

机构地区：[1]遂宁市中心医院肝胆外科,四川遂宁629000 [2]遂宁市中心医院肿瘤科,四川遂宁629000

出　　处：《肝胆胰外科杂志》2021年第11期652-656,共5页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨肝胆管结石患者在结石祛除后胆管壁病变的变化和转归。方法回顾性分析遂宁市中心医院肝胆外科从2016年1月1日至2019年12月31日24例肝胆管结石患者的胆道镜图片资料。选取每位患者其中一支有铸型结石的胆管为目标胆管,观察目标胆管在取石完成后即刻的管壁病变情况包括:黏膜充血及脱失、管壁硬化、黏膜下血管网萎缩、胆管狭窄、胆管扩张、黏膜新生物等,并在随访期内对以上黏膜病变的转归进行观察记录,评价是否有好转、不变、恶化。结果24支目标胆管在取石后95.8%存在黏膜充血及脱失;54.1%存在胆管硬化病变;100%存在黏膜下血管网萎缩,黏膜显现苍白;33.3%存在胆管狭窄;83.3%存在胆管扩张;16.6%的胆管可见乳头样新生物。经3~165周的观察发现:100%的黏膜水肿和脱失可以在1~3周内好转;15.3%的胆管硬化病变稍有好转;黏膜下血管网均未见明显恢复;胆管扩张持续存在;75%胆管狭窄恶化。有2例患者的扩张胆管内发现“草笼”状结构的絮状物。结论肝胆管结石取净后,急性炎症性黏膜病变在短期内有明显好转,但慢性硬化性胆管的管壁病变依然存在甚至会有加重趋势,这可能是导致患者结石复发和胆管癌变的病理基础。Objective To investigate the changes and outcome of biliary wall lesions in patients with hepatolithiasis after removal of the stones.Methods The choledochoscopic images of 24 patients with hepatolithiasis from Jan.1,2016 to Dec.31,2019 in the Department of Hepatobiliary Surgery of Suining Central Hospital were retrospectively analyzed.A bile duct with cast stones in each patient was selected as the target bile duct,and the wall lesions of the target bile duct after the completion of stone extraction were observed immediately as follows:Mucosal hyperemia and loss,biliary sclerosis,submucosal vascular network atrophy,bile duct stenosis,bile duct dilatation,mucosal neoplasm,were observed and recorded during the follow-up period to evaluate whether the above mucosal lesions were recovered,unchanged,worsened or not.Results Mucosal hyperemia and mucosal loss were found in 95.8%of 24 target bile ducts after stones removal.54.1%had biliary sclerosis.Atrophy of submucosal vascular network and pallor of mucosa were observed in 100%.33.3%had bile duct stenosis,83.3%bile duct dilation and 16.6%papillary neoplasm on bile duct wall.After 3 to 165 weeks,it was found that 100%of mucosal edema and mucosal loss could be recovered within 1 to 3 weeks.15.3%of biliary sclerosis was slightly recovered.The submucosal vascular network did not recover significantly.Bile duct dilatation persisted;75%of bile duct stenosis worsened.In 2 patients,a“grass cage”-like flocculent structure was observed in the dilated bile duct.Conclusion After the removal of stones,acute inflammatory mucosal lesions recover significantly in the short term,while chronic biliary wall sclerosis still exist even aggravated,which may be the pathological basis for stone recurrence and bile duct canceration in patients.

关 键 词：肝胆管结石 胆道镜 胆管壁病变 转归 胆管硬化 

分 类 号：R657.4[医药卫生—外科学]