内镜技术治疗肝胆管结石值得关注的几个问题  

Several problems worth paying attention to in the endoscopic treatment of hepatolithiasis

作　　者：冯秋实[1] FENG Qiu-shi(Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院肝胆外科,北京100034

出　　处：《中国实用外科杂志》2024年第3期267-270,共4页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82171722)。

摘　　要：在我国,肝胆管结石病是临床常见病,肝胆管结石的高残石率、高复发率、高再手术率迄今仍是胆道外科的难题。因为肝胆管结石病多合并肝胆管狭窄、反复发作的胆管炎,晚期发展至肝硬化门静脉高压症,且是发生胆管癌的重要因素,诊断和治疗均非常困难。虽然规则性肝段、肝叶切除是治疗肝胆管结石病的首选方法,近年来,肝胆管结石病微创治疗领域已取得一系列进展和突破,但仍有部分肝胆管结石难以通过手术完全去除。涉及腹腔镜、机器人手术系统、内镜等众多微创技术,其中内镜技术同样发挥了重要的作用,弥补了单纯手术治疗的不足,为不能手术肝切除或多次手术后、合并肝硬化的残留和(或)复发性结石病人的治疗带来更多的选择。内镜技术的广泛应用为肝胆管结石病的治疗注入了新的活力,使得肝胆管结石的治疗方案更为多元化。Hepatolithiasis is still a common clinical disease in China.The high residual stone rate,high recurrence rate,and high reoperation rate of hepatolithiasis are still difficult problems in biliary surgery.Because hepatolithiasis is often combined with hepatic duct stenosis,recurrent cholangitis,and advanced development to cirrhosis portal hypertension,and is an important factor in the occurrence of cholangiocarcinoma,diagnosis and treatment are very difficult.Although regular segmentalization and lobectomy are the preferred methods for the treatment of hepatolithiasis,in recent years,a series of advances and breakthroughs have been made in the field of minimally invasive treatment of hepatolithiasis,but some hepatolithiasis is still difficult to completely remove by surgery.It involves many minimally invasive technologies such as laparoscopy,robotic surgical system,and endoscopy,among which endoscopic technology also plays an important role,making up for the deficiency of surgical treatment alone,and bringing more options for the treatment of patients with inoperable liver resection or patients with residual cirrhosis and/or recurrent stones after multiple operations.The wide application of endoscopic technology has injected new vitality into the treatment of hepatolithiasis,making the treatment of hepatolithiasis more diversified.

关 键 词：肝胆管结石 胆道镜 经皮经肝胆道镜 

分 类 号：R6[医药卫生—外科学]