对肝内胆管结石规范性治疗的认识与思考  

Understanding and reflection on the standardized treatment of hepatolithiasis

作　　者：王坚[1] WANG Jian(Department of Hepatobiliary and Pancreatic Surgery,Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200233,China)

机构地区：[1]上海交通大学医学院附属第六人民医院肝胆胰外科,上海200233

出　　处：《中国普通外科杂志》2025年第2期238-244,共7页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(82273411)。

摘　　要：肝内胆管结石因易残留与复发,是其难以根治的原因,应提高对其规范性治疗重要性的认识。无法真正实行解剖性肝切除和有效纠正胆管狭窄是结石易残留与复发的根源。精准全面的术前评估是规范性治疗的前提,应重点评估结石的分布、胆管狭窄、Oddi括约肌的功能,以及肝动脉、胆管和门静脉的解剖变异,为此,笔者提出了肝内胆管结石LHO分型与肝动脉CRL分型用于指导决策。高质量的精细手术是规范性治疗的核心,及时正确处理并发症和全程规范的术后随访是规范性治疗的保证和延续。综合运用包括围肝门外科技术在内的多种技术,真正贯彻“祛除病灶,取尽结石,矫正狭窄,通畅引流”的十六字原则,规范治疗,才能提高肝内胆管结石治疗的安全性和有效性,降低残石率与复发率。The difficult radical cure of intrahepatic bile duct stones is attributed to their tendency to leave residues and recur.Therefore,it is crucial to raise awareness of the importance of standardized treatment.The inability to perform true anatomical liver resection and effectively correct bile duct stenosis are the root causes of stone retention and recurrence.Precise and comprehensive preoperative assessment is the prerequisite for standardized treatment.Attention should be focused on evaluating the distribution of stones,biliary strictures,the function of the Oddi sphincter,as well as the anatomical variations of the hepatic artery,bile duct,and portal vein.Therefore,the author proposed the LHO classification and CRL classification to guide decision-making.High-quality and meticulous surgery is the core of standardized treatment.Timely and correct management of complications and standardized postoperative follow-up throughout the process are the guarantee and continuation of standardized treatment.By integrating various techniques such as perihilar surgical techniques,and strictly adhering to the"removing lesions,removing all stones,correcting strictures,and ensuring unobstructed drainage"principle,standardized treatment can improve the safety and effectiveness of the treatment of intrahepatic bile duct stones,reducing the stone retention and recurrence rates.

关 键 词：胆石症 胆管 肝内 规范性治疗 围肝门外科技术 

分 类 号：R657.4[医药卫生—外科学]