胆肠吻合术后肝内胆管结石防治研究进展  

Prevention and treatment of hepatolithiasis after biliaryenteric anastomosis

作　　者：佟奎南 刘坤 郭伟[1] TONG Kui-nan;LIU Kun;GUO Wei(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Medical Research Center for Digestive Diseases,National Key Laboratory of Digestive Health,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,国家消化系统疾病临床医学研究中心,消化健康全国重点实验室,北京100050

出　　处：《中国实用外科杂志》2024年第3期346-348,共3页Chinese Journal of Practical Surgery

基　　金：国家重点研发计划项目(No.2017YFC0110904);北京市医院管理中心临床医学发展专项基金项目(No.XMLX202102)。

摘　　要：胆肠吻合术是治疗肝内胆管结石以及胆胰良恶性疾病常用的术式。胆肠吻合术后肝内结石复发或者由于反流性胆管炎和吻合口狭窄导致肝内结石形成均是外科临床较为棘手的治疗难题。由于胆肠吻合术后反流性胆管炎和吻合口狭窄的形成因素众多且复杂,因此,对于胆肠吻合术后肝内胆管结石的预防和治疗需从多角度予以全面考虑,其治疗的根本原则是努力达到“取尽结石、解除梗阻、去除病灶、通畅引流”的要求。目前常用的治疗胆肠吻合术后肝内胆管结石的方法包括内镜逆行胰胆管造影(ERCP)、经皮肝穿刺胆道引流(PTCD)、经皮经肝胆道镜(PTCS)、腹腔镜胆囊切除术(LC)、开放手术等。应根据病人的具体情况,选择最佳的治疗方案,尽可能地保留胆管功能,避免重复手术和并发症的发生。随着医学技术的进步和研究的深入,胆肠吻合术后肝内胆管结石的防与治将会有更好的效果和前景。Biliary-enteric anastomosis is a common procedure for the treatment of hepatolithiasis and biliopancreatic benign and malignant diseases.The recurrence of hepatolithiasis after biliary-enteric anastomosis or the formation of hepatolithiasis due to reflux cholangitis and anastomotic stricture are both challenging surgical clinical problems.Since the formation of reflux cholangitis and anastomotic stricture after the biliary-enteric anastomosis is complicated by many factors,the prevention,and treatment of recurrent hepatolithiasis after biliary-enteric anastomosis needs to be considered comprehensively from multiple perspectives.The fundamental principle is to achieve the requirements of“cleaning the stones,relieving the obstruction,removing the lesions,and facilitating the drainage”.The current common methods for treating intrahepatic bile duct stones after choledochojejunostomy include endoscopic retrograde cholangiopancreatography(ERCP),percutaneous transhepatic cholangial drainage(PTCD),percutaneous transhepatic cholangioscopy(PTCS),laparoscopic surgery(LC),and open surgery.The best treatment plan should be selected according to the specific situation of the patient,as much as possible to preserve the function of the bile duct and avoid repeated surgery and complications.With the advancement of medical technology and research,the prevention and treatment of intrahepatic bile duct stones after choledochojejunostomy will have better results and prospects.

关 键 词：肝内胆管结石 胆肠吻合术 术后复发 预防 治疗 

分 类 号：R6[医药卫生—外科学]