肝内外胆管结石的综合诊断与治疗

Comprehensive review of strategies for diagnosis and treatment of hepatolithiasis

目前针对肝内外胆管结石的检查及治疗手段很多,如何选择恰当的检查手段并制定合适的治疗方案,值得探讨。首先要了解不同检查方法的优缺点,明确患者肝胆管结石分布范围;有无合并胆管狭窄;有无合并胆管变异;有无结石相关的并发症发生等。需充分评价患者的身体状态,病程的进展情况,病情的严重程度,病变累及的范围,针对不同的患者选择适合的治疗方案。手术治疗是治疗胆管结石的主要方法,做到取净结石,解除梗阻,去除病灶,通畅引流。在病情允许的情况下尽量采用最小的创伤为患者解除病痛。

There exist many different methods for diagnosing and treating hepatolithiasis,each with a particular set of advantages and disadvantages.While some diagnostic methods can provide stone-related features,such as size and composition,others reveal anatomy-related factors,such as bile duct stricture and structural variation,as well as secondary pathogeneses,all of which may affect treatment options and outcome.Thus,an appropriate treatment strategy must be selected according to the physical condition of each individual patient that is defined by the various diagnostic methods.Regardless of disease severity and progressive nature,however,surgery remains the primary treatment modality for removing bile duct stones.The individual patient′s comprehensive profile of stone-related and anatomic-/physiologic-related features must be taken into account to identidy the most appropriate and minimally-invasive technique that will achieve complete removal of the stones,relief of the obstruction,resolution of the lesion,and proper drainage.