肝胆管结石合并门静脉高压症诊治对策

Diagnosis and management strategies of hepatolithiasis complicated with portal hypertension

肝胆管结石发展到后期常合并肝硬化门静脉高压症,这部分病人手术治疗具有高残留结石率、高复发结石率、高并发症发生率以及高再次手术率的特点。因此,在制定治疗方案前,必须对病人胆道系统、血管系统、肝脏解剖关系及肝储备功能进行精确的评估,制定系统的治疗方案,视所能达到的治疗目标、病情严重程度及矛盾的主次来决定治疗方式,慎重选择再次或多次手术,并以解除梗阻和控制感染的微创技术作为无法满足肝胆管结石治疗"三大原则"的病人治疗的首要选择。对于合并终末期肝硬化的病人应建议肝移植治疗。

hepatolithiasis will always complicate with portal hypertension in its end-stage. The surgery for these patients has a high rate of residual stones, stones recurrence, morbidity and reoperation. So, in order to generate an appropriate management strategy, the patient＇ s biliary system, vascular system, liver anatomy and function must be accurately and fully evaluated. And it should be based on the attainable treatment goals and the severity of the patient＇s condition. The surgical treatment should be carefully considered. The invasive technology of removing obstruction and controlling infection should be the first choice for those patients who can＇ t reach the ＂three principles＂ of hepatolithiasis therapy. And the liver transplantation should be recommended to those in the end-stage of cirrhosis.