病变胆管树流域切除在复杂良性胆道疾病诊疗中的理论与实践

Theory and practice of lesioned bile duct tree drainage resection in the diagnosis and treatment of benign biliary tract diseases

良性胆道疾病全球高发,因其解剖变异复杂、疾病异质性强,术前评估手段、手术技术与诊疗策略有待改进,因此患者围手术期并发症多,远期预后不良。根据胆管的解剖特点及良性胆道疾病的病理生理学特征,笔者提出以病变胆管树流域切除为核心的良性胆道疾病外科治疗理念,区别于传统胆道外科将“通与不通”作为治疗焦点,将“缓解症状”作为治疗目标,我们对术前评估、手术规划、手术操作、术后管理等进行系列改进,以治愈胆道疾病为目标,设计了系列创新性诊疗策略及术式,以期改变胆道外科的诊疗现状。

The global incidence of benign biliary tract diseases is high.Not only its anatomical variations are complex and the disease heterogeneity is strong,but also its preoperative assessment methods,surgical techniques and diagnostic and treatment strategies need to be improved.Consequently,patients have many perioperative complications and a poor long-term prognosis.According to the anatomical characteristics of the biliary tract and the pathophysiological characteristics of benign biliary diseases,we propose the surgical treatment concept of benign biliary tract diseases with the removal of the diseased bile duct tree drainage as the core,which is different from the traditional biliary surgery that takes“patency and obstruction”as the focus of treatment,and“alleviates symptoms”as the treatment goal.Through a series of improvements such as preoperative evaluation,surgical planning,surgical operations,and postoperative management,we have designed a series of innovative diagnosis and treatment strategies and procedures with the goal of curing biliary diseases,with a view to changing the diagnosis and treatment status of biliary surgery.We hope that can change the current the diagnosis and treatment status of biliary surgery.