良性胆道狭窄的病因诊断策略和治疗方式选择  

Strategy for etiological diagnosis and treatment choice of benign biliary stricture

作　　者：吴黎雳 乐金全 刘志恒 艾润垚 彭成江 钟兴伟 WU Lili;YUE Jinquan;LIU Zhiheng;AI Runyao;PENG Chengjiang;ZHONG Xingwei(The First Department of General Surgery,Southern Central Hospital of Yunnan Province/the First People's Hospital of Honghe State,Gejiu,Yunnan 661000,China)

机构地区：[1]云南省滇南中心医院/红河哈尼族彝族自治州第一人民医院普通外科一科,云南个旧661000

出　　处：《中国普通外科杂志》2023年第2期296-308,共13页China Journal of General Surgery

基　　金：青岛大学医疗集团科研专项基金资助项目(YLJT20211001)。

摘　　要：良性胆道狭窄(BBS)是肝胆胰疾病及外科手术的主要并发症之一。采用何种适当的诊断方法和策略明确病因,既不漏诊具有良性表现的恶性胆道狭窄,又避免良性疾病中不必要的手术探查,已成为胆道狭窄诊治的关键一环。在众多针对不同病因的治疗方法中,如何选择和制定合理的治疗策略,也是肝胆胰外科医生面临的问题。BBS的病因主要为医源性、感染性、炎症性、梗阻性、缺血性和自身免疫性因素等。在诊断方面,CT、MRI等影像学检查是发现胆道狭窄并初步判断良恶性的首选技术手段。结合病史、临床表现和实验室检查结果,通过肝胆外科学与影像学、病理学等多学科联合综合评估,可对BBS做出病因诊断。在治疗方面,经内镜逆行胰胆管造影(ERCP)目前仍是BBS的一线治疗手段;对于解剖结构改变或各种原因导致内镜无法通过十二指肠大乳头进入胆道的病例,可用经皮经肝胆管穿刺引流(PTBD)进行治疗;对于难治性BBS,外科手术可作为最终的保底治疗手段;磁压缩吻合、胆管内射频消融和可降解生物支架等新兴技术手段具有较好的应用前景,但仍需更多的研究数据评估疗效和安全性。Benign biliary stricture(BBS)is one of the main complications of hepatopancreatobiliary diseases and surgical procedures.The use of appropriate diagnostic methods and strategies to identify the cause of biliary stricture,can not only avoid the missed diagnosis of malignant biliary stricture with benign manifestations,but also avoid unnecessary surgical exploration in benign diseases,and has become a key element in the diagnosis and treatment of biliary stricture.Among numerous treatment methods for different causes,how to select and make a reasonable treatment strategy is also a problem faced by hepatopancreatobiliary surgeons.The etiological causes of BBS mainly include iatrogenic,infectious,inflammatory,obstructive,ischemic and autoimmune factors.In terms of diagnosis,CT,MRI and other imaging examinations are the first choice for finding biliary stricture and preliminarily determining the benign or malignant nature of the lesion.The etiological diagnosis of BBS can be made by combining the history,clinical manifestations and laboratory findings with the comprehensive evaluation of the collaborative multidisciplinary team including hepatobiliary surgeons,radiologists and pathologists.In terms of treatment,endoscopic retrograde cholangiopancreatography(ERCP)is still the first-line treatment for BBS;in the cases with anatomical changes or various reasons that cause the failure of endoscope to enter the biliary tract through the duodenal papilla,percutaneous transhepatic biliary drainage(PTBD)can be used for solution;for refractory BBS,surgery is considered as the final option;emerging techniques such as magnetic compression anastomosis,intraductal radiofrequency ablation and biodegradable stents have promising application prospects,but more research data are needed to evaluate the efficacy and safety.

关 键 词：胆道 缩窄 病理性/诊断 缩窄 病理性/治疗 综述 

分 类 号：R657.4[医药卫生—外科学]