肝胆管结石病的诊断与治疗

Diagnosis and treatment of hepatolithiasis

肝胆管结石病是腹部外科常见病,虽然其发病率呈下降趋势,但我国是该病的高发地区,仍有大量的肝胆管结石病患者.该病具有病情复杂、病变广泛、术后易复发以及术后并发症多等特点,严重影响患者的身心健康和生命质量.该病的诊断与治疗仍是一个极富挑战的外科难题.《肝胆管结石病诊断治疗指南》以及《腹腔镜治疗肝胆管结石病的专家共识（2013版）》制订了肝胆管结石病简明实用的分型系统,并提出了“去除病灶、取尽结石、矫正狭窄、通畅引流、防止复发”的指导方针,明确了以腹腔镜为代表的微创技术在肝胆管结石病中的应用价值,对我国肝胆管结石病的规范化诊断与治疗起到了巨大的推动作用.近年来的循证医学证据更进一步证实了解剖性肝切除术在肝胆管结石病治疗中的重要性.随着腹腔镜技术的迅猛进展,以腹腔镜肝切除术为主导的多镜联合治疗模式也日趋成熟.精准外科理念的兴起更为肝胆管结石病的规范化诊断与治疗注入了新的活力.

Hepatolithiasis is a common disease of abdominal surgery,although its incidence appears to decline,China is still a high incidence area with millions of patients with hepatolithiasis.Because of the complex pathogenesis,progressive development and frequent recurrence,it is seriously affecting physical and mental health of patients and quality of life,as well as difficult to define the diagnosis and select treatment methods for hepatolithiasis.The Guideline of the Diagnosis and Treatments of Hepatolithiasis and the Expert Consensus of the Laparoscopic Treatments of Hepatolithiasis （2013 edition） proposed a concise and practical classification system of the hepatolithiasis and summarized the principles of surgical treatments,which included ＆quot; resecting the lesions,cleaning the stones,correcting the stricture,recovering the drainage and preventing the recurrence ＆quot;.Meanwhile,the application of laparoscopic technique in the treatments of bepatolithiasis was proposed,which played an important role to promote the standard diagnosis and treatments of hepatolithiasis in China.Recent years,more and more evidences from evidence-based medicine further proved the importance of the anatomical hepatectomy in the treatments of hepatolithiasis.With the soaring development of laparoscopic surgery,the combination of laparoscopic hepatectomy with the assistance of other endoscopies are applied more and more frequently.The concept of precise surgery also brings new vitality to the standard diagnosis and treatments of the hepatolithiasis.