经皮经肝微创手术治疗肝胆管结石病的进展

Advances in minimally invasive percutaneous transhepatic surgery in treatment of hepatolithiasis

肝胆管结石病是常见的胆道外科疾病。传统开腹手术治疗创伤大、风险高。近年来,随着腔镜外科技术在胆道外科的迅猛发展,经皮经肝胆道取石手术尤其是经皮经肝一期胆道造瘘取石手术微创治疗肝胆管结石的优势逐步凸显,逐渐在临床应用。由于肝内胆管结石分布的复杂性和广泛性,经皮经肝胆道镜取石技术在术前规划、超声导航、胆道出血和胆道狭窄处理及术后处理等方面,尚缺乏详尽的标准。本文结合作者单位临床实践经验,就上述焦点问题简要叙述。

Hepatolithiasis is a common biliary surgical disease.The traditional treatment using laparotomy is highly invasive and risky.In recent years,rapid developments in endoscopic surgical technology in biliary surgery using percutaneous hepatobiliary lithotomy,especially using the percutaneous transhepatic one-step biliary fistulation technique has gradually been widely adopted in clinical practice because of its minimal invasiveness.The complexity and extensive distribution of intrahepatic bile duct stones have resulted in a lot of controversies in preoperative planning,use of intraoperative ultrasound,management of biliary bleeding and biliary stenosis,and postoperative management.There is a lack of universally agreed standards.Based on the author's clinical experience,this article briefly reviewed and focused to discuss on the above-mentioned controversial points.