肝胆管结石病的临床分型与手术方式选择

吕文平

肝胆管结石病的临床分型与手术方式选择

吕文平

解放军总医院肝胆外科

基金项目:

国家自然科学基金(81170429)；北京市自然科学基金(7132191)；

详细信息

中图分类号: R657.42
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出版历程
- 出版日期: 2013-06-20

Clinical classification of hepatolithiasis and choice of surgical strategy

Lu: WenPing

Department of Hepatobiliary Surgery, Chinese PLA General Hospital

Research funding:

摘要

摘要:
手术是治疗肝胆管结石病的主要手段,但是我国许多医疗机构对肝胆管结石病的手术方式选择很是不规范,导致肝胆管结石病术后结石残留率和复发率居高不下。本文认为肝胆管结石病的临床分型对肝胆管结石病手术方式的选择具有重要的临床价值,根据临床经验,分别对肝切除术、胆肠吻合术、胆管切口取石术以及肝移植治疗肝胆管结石病的适应症予以阐述。同时,将解放军总医院应用肝切除治疗肝胆管结石的手术技巧以及解剖性肝切除治疗肝胆管结石病的创新技术予以简述。
- 胆结石 /
- 外科手术 /
- 肝切除术
Abstract:
Surgery is the first-line treatment for hepatolithiasis, but the choice of surgical strategy does not meet the criteria in many medical institutions in China, resulting in high residual stone rate and recurrence rate among patients with hepatolithiasis after surgery.We think clinical classification of hepatolithiasis is great clinical significance for the choice of surgical strategy.This paper reviews the indications for hepatectomy, choledochoenterostomy, bile duct exploration and stone extraction, and liver transplantation in hepatolithiasis according to our clinical experiences.In addition, this paper gives a brief introduction to the surgical skills of hepatectomy and innovative technology of anatomical hepatectomy for treating hepatolithiasis in Chinese PLA General Hospital.
- cholelithiasis /
- surgical procedures /
- operative

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参考文献(25)

[1]Chen XG, Liu JQ, Peng MH, et al.Intrahepatic cholelithiasis inGuangxi, an analysis of 8585 cases[J].Chin J Gen Surg, 2002, 17 (2) :99-101. (in Chinese) 陈希纲, 刘家奇, 彭民浩, 等.胆石病临床流行病学调查-附8585例分析[J].中华普通外科杂志, 2002, 17 (2) :99-101.

[2]Tazuma S.Gallstone disease:Epidemiology, pathogenesis, andclassification of biliary stones (common bile duct and intrahepatic) [J].Best Pract Res Clin Gastroenterol, 2006, 20 (6) :1075-1083.

[3]Huang ZQ.Progress in hepatectomy for hepatolithiasis[J].Chin J CurrAdv Gen Surg, 2009, 12 (1) :1-2. (in Chinese) 黄志强.肝内胆管结石肝切除术的演变[J].中国现代普通外科进展, 2009, 12 (1) :1-2.

[4]Jiang ZY, Han TQ, Zhang AD.Pathogenesis of cholesterol gallstonedisease[J].Chin J Gastro, 2010, 18 (12) :1191-1195. (inChinese) 蒋兆彦, 韩天权, 张圣道.胆固醇结石病的发生机制[J].世界华人消化杂志, 2010, 18 (12) :1191-1195.

[5] Li FY, Cheng NS, Mao H, et al.Significance of controlling chronicproliferative cholangitis in the treatment of hepatolithiasis[J].World J Surg, 2009, 33 (10) :2155-2160.

[6]Nakayama F.Intrahepatic calculi:A special problem in East Asia[J].World J Surg, 1982, 6 (6) :802-804.

[7]Biliary Surgery Group of Surgery Branch of Chinese Medical Associa-tion.Guildline for management and diagnosis for hepatolithiasis[J].Chin J Dig Surg, 2007, 6 (2) :156-160. (in Chinese) 中华医学会外科学分会胆道外科学组.肝胆管结石病诊断治疗指南[J].中华消化外科杂志, 2007, 6 (2) :156-160.

[8]Kong J, Wu SD.Comprehensive review of strategies for diagnosisand treatment of hepatolithiasis[J].J Clin Hepatol, 2013, 29 (3) :163-165. (in Chinese) 孔静, 吴硕东.肝内外胆管结石的综合诊断与治疗[J].临床肝胆病杂志, 2013, 29 (3) :163-165.

[9]Huang CC.Partial resection of the liver in treatment of intrahepaticstones[J].Chin Med J, 1959, 79 (7) :40-45.

[10] Huang ZQ, Ma X.Partial resection of the liver in treatment of intra-hepatic stones[J].Chin J Surg, 1958, 6 (1) :1221-1224. (inChinese) 黄志强, 马宵.肝部分切除术治疗肝内胆管结石[J].中华外科杂志, 1958, 6 (1) :1221-1224.

[11]Uchiyama K, Kawai M, Ueno M, et al.Reducing residual and re-current stones by hepatectomy for hepatolithiasis[J].J GastrointestSurg, 2007, 11 (5) :626-630.

[12]Lee TY, Chen YL, Chang HC, et al.Outcomes of hepatectomy forhepatolithiasis[J].World J Surg, 2007, 31 (3) :479-482.

[13]Chen DW, Tung-Ping Poon R, Liu CL, et al.Immediate and long-term outcomes of hepatectomy for hepatolithiasis[J].Surgery, 2004, 135 (4) :386-393.

[14]Hasegawa K, Kokudo N, Imamura H, et al.Prognostic impact ofanatomic resection for hepatocellular carcinoma[J].Ann Surg, 2005, 242 (2) :252-259.

[15]Jarufe N, Figueroa E, Muoz C, et al.Anatomic hepatectomy as adefinitive treatment for hepatolithiasis:a cohort study[J].HPB (Oxford) , 2012, 14 (9) :604-610.

[16]Jiang H, Wu H, Xu YL, et al.An appraisal of anatomical and lim-ited hepatectomy for regional hepatolithiasis[J].HPB Surg, 2010, 2010:91625.

[17]Cai SW, Lu WP, Yang SZ, et al.Application of persistent methyl-ene blue dyeing method for anatomic hepatotectomy of hepatocehularcarcinoma with bile duct tumor thrombi[J].Chin J Surg, 2012, 50 (6) :502-504. (in Chinese) 蔡守旺, 吕文平, 杨世忠, 等.持久亚甲蓝染色法在肝细胞癌合并胆管癌栓解剖性肝切除术中的应用[J].中华外科杂志, 2012, 50 (6) :502-504.

[18]Cai SW, Xie Y, Yang SZ, et al.Application of lasting methyleneblue staining in precise hepatectomy[J].Chin J Dig Surg, 2010, 10 (1) :28-30. (in Chinese) 蔡守旺, 谢于, 杨世忠, 等.持久美蓝染色法在精准肝切除中的应用价值[J].中华消化外科杂志, 2010, 10 (1) :28-30.

[19] Dong JH, Zhen SS, Chen XP, et al.Consensus on evaluation ofHepatic functional reserve before hepatectomy[J].Chin J DigSurg, 2011, 10 (1) :20-25. (in Chinese) 董家鸿, 郑树森, 陈孝平, 等.肝切除术前肝脏储备功能评估的专家共识 (2011版) [J].中华消化外科杂志, 2011, 10 (1) :20-25.

[20]Dong J, Lau WY, Lu W, et al.Caudate lobe-sparing subtotalhepatectomy for primary hepatolithiasis[J].Br J Surg, 2012, 99 (10) :1423-1428.

[21]Wan T, Zhou NX.Preserve sphincter of Oddi function in operationfor hepatolithiasis[J].Chin J Pract Surg, 2004, 24 (2) :119-120. (in Chinese) 万涛, 周宁新.保留Oddi括约肌在肝胆管结石病外科治疗中的意义[J].中国实用外科杂志, 2004, 24 (2) :119-120.

[22]Yuasa N, Miyata K, Kobayashi Y, et al.Mucosal dysplasia in thebile duct after choledochoduodenostomy:a case report[J].Hepato-gastroenterology, 2000, 47 (35) :1238-1240.

[23]Kuo K, Ker CG, Sheen PC, et al.Changes of bile duct mucosa af-ter choledochoduodenostomy in rats[J].Eur Surg Res, 1996, 28 (1) :63-69.

[24] Dong JH, Huang ZQ.Precise liver resection—new concept of liversurgery in 21st century[J].Chin J Surg, 2009, 47 (21) :1601-1605. (in Chinese) 董家鸿, 黄志强.精准肝切除———21世纪肝脏外科新理念[J].中华外科杂志, 2009, 47 (21) :1601-1605.

[25]Lu WP, Huang ZQ, Dong JH.Biliary injury in laparoscopic chole-cystectomy[J].Chin J Surg, 2008, 46 (6) :463-464. (in Chi-nese) 吕文平, 黄志强, 董家鸿.腹腔镜胆囊切除与医源性胆管损伤[J].中华外科杂志, 2008, 46 (6) :463-464.

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