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今天给大家分享管道知识，疏通肝胆管结石。它还将解释肝脏和胆管中的结石。如果正好解决了你现在面临的问题，别忘了关注本站，我们现在就开始吧！
本文内容一览：
1．肝内胆管结石的治疗方法是什么？ 2、肝内胆管结石如何治疗？ 3、胆管结石堵塞怎么办？ 4、如何治疗肝结石？ 5、肝内胆管结石如何治疗？ 6. 治疗胆管结石最好的方法是什么？肝内胆管结石的治疗方法是什么？
首先，肝内胆管结石的治疗是临床手术中的难题。由于认知、解剖、病理和技术等方面的原因，肝内胆管结石的治疗还存在诸多问题，影响了治疗效果。因此，我们要特别注意，认真对待。
（一）肝内胆管结石手术治疗的难点
由于肝胆管结石的病理十分复杂，是不同于胆囊结石的另一种疾病意识形态方面。不能按照治疗胆结石的原则和方法治疗肝胆管结石。胆囊结石可以口服或穿刺滴注化石药治疗，也取得了一定的疗效。肝内胆管结石目前尚无理想的溶石药。胆囊结石可以通过切除胆囊彻底治疗。肝内胆管结石不能从胆管中广泛清除。此外，肝内胆管结石散在肝内外，常伴有肝外胆管狭窄和扩张。被处理。有时患者处于急性胆管炎、休克等危重状态，急诊手术，术前情况不明或仅采取急救措施，遗留肝内病灶。肝胆管结石合并肝硬化、门脉高压、手术治疗难度大等原因，导致肝胆管结石手术治疗，术后常发生残余结石和胆管狭窄。据国内统计，肝胆管结石手术后，残余结石的发生率高达%至%，左侧肝内胆管狭窄所占比例更大，因此约%的病例需要再次行胆道手术。严重的是，随着手术次数的增多，很多患者的病理情况更加复杂，更容易发生胆管狭窄，需要再次手术。因此增加了手术并发症和死亡率。
（二）肝内胆管结石的手术治疗原则
随着医疗水平的提高和诊疗技术的进步，在治疗上已完善了系统的方法肝胆管结石的治疗，必须坚持完整、综合、辩证的原则。影像学检查和肝门解剖立体成像的概念使得传统的肝外手术向肝内手术转变成为可能。对于肝内胆管结石的治疗，采用肝外科技术对肝门部和肝内胆管进行处理，达到良好的显露，形成了较为完整的肝胆管结石手术治疗原则，即取石、去除病灶、并纠正胆管。狭窄，恢复和建立胆道的生理功能和畅通胆汁流动，避免和预防胆道感染和结石的复发。
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（三）准备术前，避免急诊手术
按照治疗原则进行系统规划和整体设计。对于肝内胆管结石患者，尽量不要在紧急情况下进行手术，尤其是在病理情况不明的情况下。可采用中西医结合给予适当抗生素，经鼻胆管胆管减压，或经皮肝胆管引流纠正水电解质紊乱和酸碱平衡，度过急诊期。
术前积极治疗各种并发症，诊断清楚胆结石的位置、胆管狭窄的部位和程度、肝内外胆管的病理情况、肝功能和一般情况。根据病灶和实际可能，制定治疗方案，力争做好第一次手术。如果是经过多次手术的病例，应慎重考虑，精心设计，争取做最后一次手术。
(4)联合手术及后续治疗
①联合手术。肝、胆管结石的手术治疗要求很难用某种手术方法一次手术完全解决。多种手术方法必须结合、互补才能满足治疗的需要。例如左叶结石或肝左叶纤维化，肝组织萎缩，肝左叶或肝左叶切除是可能的；若同时并发肝门部胆管狭窄，行肝门部胆管成形术；如果胆管组织有缺陷，可以进行胆囊瓣或圆韧带修复；如果缺损较大，也可用胃或空肠带血管蒂皮瓣修复。只要肝外胆管下端没有狭窄，就应该采用胆管成形术来保留肝外胆管和胆总管末端括约肌的功能。
如肝左右叶广泛结石，累及肝门部胆管狭窄，可从肝管切开，显露肝内1～2级肝管。肝脏向上，解除胆管狭窄，解除肝内狭窄。石头。
用超声碎石镜直接进入肝内胆管碎石，因为有电视监控，可以到达3~4级胆管碎石，同时破碎吸出当时，大部分病例可以在手术中将结石全部取出，术后胆道镜治疗提高了肝内胆管结石的治疗效果。
如果肝外胆管狭窄不能再使用，或患者再次手术，治疗肝内结石，胆管狭窄解除后，行肝门部胆管Rouxen-Y吻合术或者肝内胆管和空肠应该做。重要的一点是，如果肝脏残留病灶，尤其是肝内胆管狭窄不解除，在狭窄以下行胆肠吻合术，术后胆汁引流通畅是解决不了的，而且肠胆反流会增加，出现胆道反流。感染或严重胆管炎或结石复发是再次手术的常见临床原因。
②后续治疗。即在手术过程中放置??肝内或肝外肝内导管。该导管可以是简单的导管或气囊导管。置管的位置取决于肝内外有无残留结石、有无胆管狭窄及导管的功能。有的肝内外胆管狭窄或吻合口中的支持导管、球囊导管需长期保留，一般为6至数月。对于需要长期插管的患者，可采用U型管减少胆汁丢失。手术后胆内导管可发挥多种作用：引流感染的胆汁；支持胆管吻合术；液压冲击碎石术；经导管窦道，使用胆道镜清除残余结石或碎石术；经导管胆管造影，观察肝内外胆管的病理情况，决定下一步治疗及是否拔管。这些措施是手术治疗的延续和补充。只有将联合手术与后续治疗很好地结合起来，才能提高肝内胆管结石手术治疗的效果。
（五）肝胆管结石几个疑难病症的治疗
①肝胆管结石合并肝硬化门静脉高压症。肝胆管结石肝脏的病理改变主要是胆管周围的肝组织和汇管区。随着慢性炎症的发展，肝组织纤维化，门静脉腔缩小，血管壁增厚。门静脉区肝动脉明显扩张，内径增粗，门静脉血流受压，回流血减少，肝组织萎缩是门静脉高压症的病因。再加上反复发作的胆管炎和胆管周围炎、胆汁淤积、肝细胞损伤和再生，形成胆汁性肝硬化，病情加重出现门静脉高压症。因此，肝胆管结石患者的门静脉高压症是继发性的，是长期胆管阻塞和严重黄疸、肝硬化的结果。此类患者除了一般的门体间侧支循环外，在肝门的肝外胆道区还存在大量静脉网和静脉曲张。手术中最大的困难是手术过程中无法控制的大出血，这也是手术失败的主要原因。如果是再次手术，那就更难了。治疗原则：对于此类复杂病例，首先要加强术前准备，控制感染，改善肝功能，然后分阶段进行手术。
第一步是进行脾切除和肠腔分流，以降低门静脉压力，为减少手术出血做准备。第二步，术后3-6个月，根据情况进行肝胆管结石的彻底手术。
②肝胆管结石多次手术再手术。由于肝胆管结石病理的复杂性，术后胆结石的残留率和复发率很高，或因前期手术方法不当，反复发生反复化脓性胆管炎，造成多次手术，使病理情况更加复杂。当需要再次手术时，无疑会增加手术的难度。处理原则除参考胆道再手术相关问题外，还应重点关注以下几点：一是术前加强全身情况的改善，综合分析再手术的原因。流，纠正既往手术的缺陷，改善或设置抗胆汁反流措施，减少术后胆道感染和结石复发。其次，选择合适的手术入路进行手术，经肝包膜切开深部胆管，显露肝横裂深部胆管。外分离，电凝止血，仔细辨认组织，切忌盲目夹闭，必要时缝合止血。同时需要考虑肝胆管结石患者肝脏的转位和肝门结构的移位。边穿刺边分离可发现肝外胆管。第三，结合B超和术中造影，当肝门确实难以解剖时，可通过肝实质切开胆管取出结石或引流。
③肝内胆管残余结石的治疗。肝胆管结石术后仍有残留结石，是外科治疗中的难题。尽管手术技术不断改进，但肝内胆管结石术后残留结石的发生率仍然很高。据统计，我国1省市肝内胆管结石术后残石发生率为.%，另有报道术后残石率高达.%。
治疗原则：积极治疗残余结石引起的并发症，如胆道感染、肝脓肿、梗阻性黄疸等。
术后有胆管者，4～6术后数周，可通过胆道镜经导管窦进行碎石取石。方法：如有胆管狭窄，应先经窦道行胆道镜检查或气囊导管扩张术。也可与十二指肠镜联合进行乳头括约肌切开术，解决胆总管下端狭窄。胆道镜取石时，胆道镜应小心轻柔地穿过导管的窦道。根据术前诊断及胆管内情况，如胆管炎症、絮状物等，确定残石位置，或在B超引导下进入肝内胆管。对于大石块，先用石钳将其压碎，再夹出。切除肝内胆管后，检查肝外胆管，直至胆总管下端开放。如果一次不能取石，可以多次取石。每次手术间隔3～5天。如果发生术后胆管炎，应在炎症得到控制后进行取石。每次取石后，应将导管重新置入胆管内，一方面便于引流，也为后续取石创造条件。 4级以上肝内胆管，如胆道镜不能进入，可先用音频水力震碎结石，使周围胆管内的结石松动，直至到达胆囊，再取出结石。石头。或用细胆道镜至胆管口处，用取石钳进入远端胆管取石。
难以处理的残石是因为T型管或肝内导管直径过小，或导管窦道迂曲，胆道镜无法进入。这种情况应先用导丝引入导管，间隔3～5天更换较粗的导管，逐渐扩宽，或由导丝引导进入胆道镜取石。二是残石胆管分支狭窄，多为较窄或膜性狭窄，多数可经胆道镜直接扩张通过。如果狭窄严重，胆道镜难以扩张，则需要进入导丝引导扩张管，先扩张，再用胆道镜取出结石。此外，由于残留的结石位于肝右叶后支或尾支，胆管开口成角度，不易发现或进入胆道镜。对于这种情况，术前应参照B超、CT、ERCP等影像学检查，研究残留结石的位置，并在B超引导下，从窦道进入胆道镜，寻找开口处。胆管。如果开口角度太小，可用胆道镜侧弯取石。
没有胆管的患者术后残留结石的处理难度更大。因此，术后拔除胆道引流管前，应常规行胆管造影或胆管镜检查，确认无残留结石及胆管狭窄后方可拔管。如果在没有胆道引流管的情况下发现残留结石，治疗方法包括：服用中药排石，适用于肝内外胆管无狭窄，结石不是太大（0.5- 1.0cm），胆结石位于胆管或胆总管内。
采用疏肝利胆方，加贴电极板、射流振子、经络按摩器、按穴或针灸排石等。当胆结石位于胆总管时, 可通过十二指肠镜取石篮取出结石，必要时应先行内镜下 Oddi 括约肌切开术 (EST)。经皮选择性胆道插管术（SPTCD），可滴注6-偏磷酸钠、依地酸二钠、胆酸、肝素、橙油、猪胆汁等溶石剂。在这种情况下，结合音频水力振动碎石，可以提高清除残石的效果。使用经皮经肝胆管镜或经口胆管镜去除结石并放置内部支撑管治疗胆管狭窄。
怎样治疗肝内胆管结石比较好？
肝内胆管结石的治疗方法很多，大致分为两种：手术治疗和药物治疗。手术治疗主要包括传统手术和体外冲击波碎石术。每种治疗方法都有其不可避免的局限性。和传统的手术治疗一样，要么尽量忍着，要么直接切除肝胆，让患者望而却步。对身体的伤害也是很大的。体外冲击波碎石术已被临床证明是极其危险的。稍有不慎，就会造成碎石堵塞胆管，落入食道等诸多严重后果。药物治疗主要分为中药和西药。但西医治疗不能作为一种独立的治疗方法，只能起到消炎止痛的辅助作用，不能消融结石。最好的治疗方法是中药。中药以其特殊的药性，不仅治疗效果好，而且安全高效，无毒副作用，不会造成任何伤害，适合各个年龄段的患者。苗寨十清方是一味中药，选用有天然药材宝库之称的黔东南州雷山县雷公山黄芪、茯苓、鸡翅目、钱草等当地天然药材。经炮制，治疗肝内胆管结石疗效显着！肝内胆管结石患者的饮食应遵循高蛋白、高维生素、高纤维、低脂肪的原则，多吃新鲜鱼、蛋、瘦肉、新鲜蔬菜、水果等淀粉类主食，如大米、面粉等不限，从而达到增加营养、保护肝细胞的目的。
胆管结石堵塞怎么办？
胆总管结石是指肝内外胆管结石形成，是最常见的胆道系统疾病。胆管结石阻塞导致胆汁淤滞，随后细菌感染导致急性胆管炎。反复的胆管炎症可引起局部管壁增厚或瘢痕狭窄，胆管炎症和狭窄可促进结石形成。胆管狭窄近端被动扩张，内压增高。胆管结石阻塞胆总管会引起继发于细菌感染的胆管炎。当结石阻塞胆囊管或胆总管时，会引起急性胆绞痛，严重时难以忍受，并伴有右腰痛，伴有高热、寒战、恶心、呕吐，甚至滴血压力、烦躁、休克和昏迷是危及生命的。
胆管结石引起胆总管梗阻的症状： 1.胆结石引起的胆总管梗阻患者会出现上腹痛。疼痛一般位于上腹部中部或右上腹部，常表现为突然发作，程度通常较重，并伴有恶心、呕吐。 2.合并细菌感染时，腹痛后患者会出现寒战、寒战和发热。 3、患者在感到腹痛后的第二天，眼白和皮肤会变黄，小便颜色会变深。肝内胆管结石对身体的危害取决于其大小和位置。有些小结石可能没有任何症状，有些小结石可能会引起胆管小端疼痛、发炎等症状；如果结石变大堵塞胆管，摩擦胆管会引起胆汁淤积、胆管炎症等。因此，肝内胆管结石的主要危害不是结石本身，而是胆汁淤积、肝功能损害、肝细胞水肿、结石阻塞肝内胆管引起的肝萎缩、胆汁性肝硬化等。早期因为没有任何不适症状，所以很多人并没有太注意这个病。一旦结石引起腹痛、黄疸、发热等症状，往往会对肝功能造成严重损害。温馨提示：胆管结石的治疗一定要到专业的结石病医院进行治疗，患者切不可盲目用药，不仅于事无补，还可能加重病情，不利于恢复患者。贵阳结石病医院在治疗胆管结石方面取得了良好的效果。专家建议，应积极到专业医院检查、诊治。为了确保您掌握最佳治疗时机，患者在身体出现异常时一定要及时发现并进行治疗。权威专家【推荐技术】： 胆总管结石的终结者——ERCP技术 ERCP（endoscopic retrograde cholangiopancreatography）是在电子十二指肠镜下经口腔经十二指肠乳头注入造影剂。因此，逆行显示胰胆管造影技术是目前国际公认的胰胆管疾病诊断金标准。作用：在ERCP的基础上，可进行括约肌切开术（EST）、胆管结石碎石术、胆总管支架置入术、内镜下鼻胆汁引流术（ENBD）、内镜下鼻胆管引流术（ENBD）。碎石、碎石等介入疗法可以快速、安全、有效地治疗胆管结石等疾病，无需开刀，创伤小，住院时间大大缩短，深受患者欢迎。方法：经内镜逆行胰胆管造影术是将纤维性十二指肠插入十二指肠降部，找到十二指肠的大乳头，从活检管路将塑料导管插入乳头的开口处，注入造影剂X线片显示胰胆管。同时进行相关手术治疗。如发现肿瘤，可取标本作病理检查或置入胆管支架。如果有结石，可以用相关工具将结石取出。 ERCP的五大优势： 1、诊断准确，治疗成功率高。 2、不开刀，无伤口，生理干扰小，患者痛苦小。 3、风险小，安全性高，既消除病灶，又不留痕迹。 4、恢复快，一般术后三天即可出院，减少住院时间。 5、见效快，重复性强，并发症少。适应症：胰胆疾病，尤其是胆管结石。 ERCP具有检查与治疗并举的优势，成功率逐渐提高，目前已达到%以上，已成为胰腺、胆道疾病诊治的重要手段。以上是贵阳结石病医院的专家们为“刚确诊，还没治疗，想试试保守治疗，中药复发，保守治疗无效，手术后，我在一头雾水。了解微创治疗
肝管结石怎么治疗
肝内胆管结石的治疗还是以手术为主，且疗效较好，对于右肝管分支结石及合并胆管狭窄者，手术治疗疗效仍不理想的约占%，故术后中西医结合药物治疗
手术治疗原则：①尽量清除结石，解除胆管狭窄；②在纠正胆道狭窄、解除狭窄的基础上进行胆肠引流阻塞以扩大胆管的流出； ③如果病变局限于左肝叶，可采用肝叶切除术治愈病变。
手术方法：一般采用高位胆管结石清除。胆总管切口最好延伸至肝管汇合处，直视下从左侧通过
p>彻底清除右侧肝管开口处各分支结石胆管，同时切开狭窄的肝内胆管。若结石位于肝浅部，经肝实质切开肝内胆管，取出结石，置T管或做胆管肠引流。胆道引流一般采用肝管、肝总管或胆总管空肠Roux Y吻合，或胆管十二指肠间置空肠吻合。近年来，也有不少人进行胆管与空肠吻合术，将空肠环的一端做成皮下盲环，术后可通过此方式进行胆道镜检查或取石。 Oddi括约肌整形胆总管十二指肠吻合术常引起严重的逆行感染，因此近年来已很少用于肝内胆管结石的治疗。对于无法切开的右肝管二级及以上分支狭窄，可经胆管切口扩张，置入长臂T管或U型管支持引流，此那种引流管一般需要放置1年以上。肝叶切除术是指切除肝内病灶，主要指肝左叶切除术。肝左侧叶切除术是最常用的手术方法。通过肝切面的肝内胆管进一步切除 对于胆结石，在肝切面对肝内胆管和空肠进行RouxY吻合。若右肝管内同时有少量结石，也可行肝内外联合胆管空肠吻合术。对于右肝内胆管结石，也有人进行右肝叶切除术，但多数人认为这种手术侵入性太大，不宜采用。因此，如果双侧肝脏广泛多发性结石或右侧肝内胆管结石，一般不做肝叶切除术，应尽可能切除结石，RouxY型空肠胆管手术
肝内胆管结石如何治疗？
肝内胆管结石与诊断
1.肝内胆管结石的流行病学及发病机制
肝内胆管结石是指左右肝管汇合处以上的胆管结石。也可与肝外胆管结石共存。该病多见于远东和东南亚地区，包括中国、日本、朝鲜、菲律宾、泰国、印度尼西亚和马来西亚等国家。我国沿海地区、西南地区、香港、台湾等地区发病率较高。病因与胆道细菌感染、寄生虫感染和胆汁潴留有关。感染是导致结石形成的首要因素。感染的常见原因是胆道寄生虫感染和复发性胆管炎。几乎所有肝内胆管结石病患者的胆汁培养均可检出细菌；感染菌主要来自肠道，常见菌有大肠杆菌和厌氧菌。 B-glucuronidase produced by Escherichia coli and some anaerobic bacteria infection and endogenous glucuronidase produced by biliary tract infection can hydrolyze conjugated bilirubin to generate free bilirubin and precipitate it. Bile retention is a necessary condition for the formation of intrahepatic bile duct stones. Only under the condition of bile retention can the components in bile deposit and form stones. Inflammatory stenosis of the biliary tract and malformation of the biliary tract cause bile retention; the pressure in the distal bile duct of the obstruction increases, the bile duct dilates, and the bile flow slows down, which is conducive to the formation of stones. In addition, macromolecular substances such as mucin, acidic mucopolysaccharides, and immunoglobulins in bile, inflammatory exudates, exfoliated epithelial cells, bacteria, parasites, and metal ions in bile all participate in the formation of stones.
II. Diagnosis of intrahepatic bile duct stone disease
(1) Clinical features of intrahepatic bile duct stone disease
Intrahepatic bile duct stone disease is based on the course of disease and pathology Its clinical manifestations can be multifaceted, ranging from stones confined to a certain section of the intrahepatic bile duct in the early stage without obvious clinical symptoms to spreading throughout the extrahepatic bile duct system and even complicated by biliary cirrhosis, liver atrophy, and hepatic cirrhosis in the later stage. Advanced cases such as abscess, so the clinical manifestations are very complicated. Its clinical manifestations are mainly acute cholangitis, including the pentalogy of severe cholangitis of the triad of biliary obstruction (pain, chills, fever, and jaundice). Its clinical features are:
1. Age of onset - years old;
2. Epigastric pain, which may be typical biliary colic or persistent pain, and some patients have no obvious pain , but the chills and fever are very severe and occur periodically;
3. There may be a long-term history of biliary tract disease, or a history of acute cholangitis accompanied by chills, fever, and jaundice;
4. The affected side Frequent pain and discomfort in the liver area and lower chest, often radiating to the back and shoulders;
5. When one side of the hepatic duct is obstructed, there may be no jaundice or very mild jaundice;
6. When combined with severe cholangitis, the general condition is more serious, and the recovery is slow after the acute attack;
7. During the examination, tenderness and percussion pain in the liver area are obvious, and the liver is asymmetrically enlarged And there is tenderness;
8. The general condition is obviously affected. % of the patients have hypoalbuminemia, and 1/3 of the patients have obvious anemia;
9. Liver and splenomegaly in the late stage Large and portal hypertension performance.
(2) Diagnostic methods
In addition to improving the understanding of the disease clinically, the diagnosis of intrahepatic bile duct stones mainly depends on the findings of imaging examinations. The main imaging techniques used are B-ultrasound, CT and X-ray cholangiography.
1. B-ultrasound diagnosis
B-ultrasound is the first choice for the diagnosis of intrahepatic bile duct stones, and the diagnostic accuracy is generally estimated to be %-%. Ultrasonic images of intrahepatic bile duct stones change frequently, and the diagnosis of intrahepatic bile duct stones generally requires dilation of the bile duct distal to the stones, because calcification of the intrahepatic duct system also has stone-like imaging manifestations.
2. CT Diagnosis
Because intrahepatic bile duct stones are mainly pigmented stones containing bilirubin calcium, and the calcium content is relatively high, they can be clearly displayed on CT photos , The diagnostic coincidence rate of CT is %-%. CT can also show the position of the hepatic hilum, dilatation of the bile duct, and changes in liver hypertrophy and atrophy. Systematic observation of CT photos at each level can help understand the distribution of stones in the intrahepatic bile duct.
3. X-ray cholangiography
X-ray cholangiography (including PTC, ERCP, TCG) is a classic method for the diagnosis of intrahepatic bile duct stones, and generally can make correct Diagnosis, the diagnostic coincidence rates of PTC, ERCP and TCG are %-%, %-%, %-%. X-ray cholangiography should meet the needs of diagnosis and surgery. A good cholangiogram should be able to fully understand the anatomical variation of the intrahepatic biliary system and the distribution of stones. The following issues should be paid attention to in cholangiography:
(1) Multi-directional X-rays should be taken;
(2) When the bile duct of a certain liver segment or lobe does not develop, attention should be paid to Stone obstruction is only one of the reasons, and other examinations should be used for identification;
(3) Do not satisfy the diagnosis of a certain lesion, because it may cause missed diagnosis;
(4) When analyzing cholangiograms, the most recent ones should be obtained as much as possible, because the disease may progress.
(3) Early diagnosis of intrahepatic bile duct stone disease
Currently, clinically treated intrahepatic bile duct stone disease is mostly caused by cholangitis, bile duct stricture, obstruction, and liver atrophy Wait for serious pathological changes before seeing a doctor. Although the imaging diagnosis and surgical techniques of hepatobiliary surgery have made great progress, the current situation of high stone recurrence rate and reoperation rate after surgery has not been significantly improved. Therefore, the treatment of intrahepatic bile duct stones Early diagnosis and treatment may be the key to changing this situation. Early diagnosis of intrahepatic bile duct stones includes:
(1) Chronic right upper abdominal pain and discomfort can exclude other diseases;
(2) B-ultrasound indicates intrahepatic bile duct stones (should be related Calcification identification of other pipeline systems in the liver);
(3) CT shows multiple stone shadows in the liver, and they are segmentally distributed;
(4) ERCP confirms a segmental Those with stones in the liver and bile ducts.
3. Complications of intrahepatic bile duct stones
The main pathological changes of intrahepatic bile duct stones are biliary obstruction and infection; due to the direct relationship between the hepatic duct system and liver parenchymal cells, Severe hepatic cholangitis is often accompanied by severe liver cell damage, and even leads to large areas of liver cell necrosis, which has become the main cause of death in benign biliary tract diseases. Complications of intrahepatic bile duct stones include acute and chronic complications.
(
1) Acute phase complications
The acute phase complications of intrahepatic bile duct stones are mainly biliary tract infection, including severe hepatic cholangitis, biliary Hepatic abscess and associated infectious complications. The cause of infection is related to stone obstruction and inflammatory stenosis of the biliary tract. Complications in the acute phase not only have a high mortality rate, but also seriously affect the surgical effect.
(2) Chronic phase complications
Chronic phase complications of intrahepatic bile duct stone disease include systemic malnutrition, anemia, hypoalbuminemia, chronic cholangitis and biliary Liver abscess, multiple hepatic bile duct strictures, fibrotic atrophy of liver lobes, biliary cirrhosis, portal hypertension, hepatic decompensation, and late-onset hepatic cholangiocarcinoma associated with prolonged biliary infection and bile retention. Chronic complications of intrahepatic bile duct stones not only increase the difficulty of surgery, but also affect the effect of surgery.
四个。 Surgical treatment of intrahepatic bile duct stones
(1) Principles of surgical treatment of intrahepatic bile duct stones
Treatment of intrahepatic bile duct stones It is still one of the important topics to be studied in hepatobiliary surgery. The principle of treatment of this disease is to relieve obstruction, remove lesions and unobstructed drainage. These three aspects are closely related and indispensable. Relief of calculus and/or narrow obstruction is the key to surgical treatment; removal of lesions is the core of surgical treatment, and at the same time it is often an important means to relieve obstruction; unobstructed drainage is to prevent recurrence of infection and calculus regeneration, but it must be based on the premise of removing the obstruction and removing the lesion. Non-surgical treatment can only be effective after completing the above three basic requirements.
(2) Basic surgical methods and options for surgical treatment of intrahepatic bile duct stones
1. Hepatic lobectomy This operation was first advocated by Professor Huang Zhiqiang for intrahepatic bile duct stones disease, and will be widely used in the future. Due to the resection of the diseased liver tissue and the removal of purulent lesions, the thoroughness of the operation is increased, which is conducive to improving the curative effect of the operation. Lobectomy includes curative liver resection and auxiliary liver resection. Indications for curative hepatectomy include stenosis and calculus of a certain liver lobe (segment), multiple stenosis of the hepatic and bile ducts, or complicated with chronic liver abscess, or hepatic and bile duct fistula, or suspected cancer. The purpose of auxiliary liver resection is to remove the square lobe of the liver or the lower part of the middle lobe of the liver to fully expose the intrahepatic bile ducts and increase the space for dealing with hilar cholangiopathies or biliary-enteric anastomosis.
2. Biliary-enterostomy
The basic procedure of biliary-enterostomy is Roux-Y anastomosis of bile duct and jejunum, and the bridge should be no less than cm. The basic premise of cholangioenterostomy is to remove the lesion and relieve stones or bile duct stricture, otherwise biliary enterostomy should not be performed. Biliary-enteric anastomosis requires low position, large diameter (such as basin anastomosis), mucosa-to-mucosal anastomosis, etc.
3. Bile duct drainage
Bile duct drainage is only suitable for some special cases, such as emergency patients, or transitional surgery combined with portal hypertension, or those who cannot tolerate Elderly patients undergoing complicated operations such as liver lobectomy, or cases with poor general condition. Due to the need for long-term support and drainage with a tube, the further formation of stones can be promoted, and the curative effect is poor.
Cholelithiasis
Why is cholelithiasis a hot topic?
It is by no means alarmist. Cholelithiasis is really a fashionable disease. We have seen many people holding medicine jars to drink medicine every day. Cholelithiasis is not a disease that only modern people get. The pharaohs in ancient Egypt were troubled by cholelithiasis, which shows that it has a long history. However, there are so many cholelithiasis today that adults, especially women, should be alert to cholelithiasis as long as they often feel heaviness in the upper abdomen, soreness in the back and right shoulder, hiccups, and belching. There are also many patients who have been diagnosed by doctors as stomach problems and have not recovered for many years. In fact, they are also caused by cholelithiasis. There are also many patients with gallstone attacks who are misdiagnosed as angina pectoris and coronary heart disease. Cholelithiasis can be said to be an epidemic among urbanites. According to statistics, about % of adults suffer from cholelithiasis, and in middle-aged women, the incidence of cholelithiasis is even as high as %. In hospitals in western countries and some big cities in my country, the number of patients hospitalized for surgery due to cholelithiasis has surpassed that of appendicitis, becoming the veritable No. 1 surgical disease.
What is cholelithiasis?
Cholelithiasis, in short, is gallstones in the gallbladder. Due to hepatic metabolic disorders or biliary motor dysfunction, the solid components in the bile are precipitated, and stones are formed in the gallbladder where the bile flow rate is slow and the bile concentration is high. Gallstones can be as small as rice grains or as large as walnuts. There can be one, two, or thousands of gallstones. A few years ago, we performed a cholecystectomy, and there were several stones in the gallbladder. Under normal circumstances, once the stones are formed, they will accumulate more and more, and grow bigger and bigger. If there is a stone stuck in the cystic duct with a relatively small diameter.就会引起相当剧烈的上腹疼痛，疼痛可以放射到后背及右肩部，病人还常伴有恶心及频繁的呕吐(干呕)，用“死去活来”形容一点也不过分，这就是通常所说的胆绞痛。严重者甚至可发生胆囊化脓、穿孔，黄疸、胰腺炎等。
可不可以服药把胆石排出来
病人每次发作胆绞痛都可以说是机体的生理反射机制在努力想把胆石排出来，或者说挤出来。挤到哪里去呢？挤到胆管中。在胆道系统中，胆囊好比一个水库，胆总管是胆汁的排出通道，就是胆汁的总出口。我们见到一些病人在几次三番的胆绞痛发作后，石头侥幸从胆管中挤出来，并随大便排出体外，但这是可遇而不可求的事。由于胆管的开口很窄小，更多见的情况是石头卡在这儿不能排出，这样病人会出现严重的问题，如更剧烈的腹痛、发高热及黄疸，甚至发生败血症、休克、死亡。由此可知，病人绝不可以服用药物排石，那样只会适得其反，招来更大的麻烦。
可不可以用药物将结石溶化掉？
药物溶石的历史很久远，人们研究过形形色色的溶石药物，以目前疗效最确切、毒性相对较小的熊去氧胆酸来说，如果坚持服药一年，大约％-％的病人的结石可完全消失。且不说耗时费力，药物价格不菲；也不说这种药物有相当毒性，最麻烦的是一旦停药，大多数病人的胆石又会重新出现，使以前的努力付诸东流。因此此法只适宜用于少数症状很重、体质状况又不容许做胆囊切除术的病人。至于目前市面上很多号称能溶石的药物，我们没见到科学证据。
体外超声波碎石怎么样？
这是一种新的治疗手段。在有选择的病人中，平均经1-2年的治疗，绝大多数病人的结石可以破碎，被排出体外，约半数病人的结石可以排净。但停止治疗之后很多病人的胆囊结石又会重新出现。而且在排石过程中，随时有碎石掉到胆管中排不出去，从而诱发危险的胆总管结石的可能性，因此采用此种方法应该慎重，权衡利弊。
可不可以把结石掏出来？
回答是可以的。譬如说把胆囊切开一个小口，改进胆道镜取出结石、也可以用钳子直接取出结石，再把切口缝上。其实这是人类最古老的治疗胆结石的手段，只是由于弊病甚多，被胆囊切除术取代了。今天可以说这种治疗方法，已经完全没有实用意义了。
切除了胆囊，胆管就会长结石，结果更可怕，是这样吗？
这种说法毫无科学根据。事实是保留有结石的胆囊，倒会增加胆管结石的机会。不少胆管结石的病人，石头都是从胆囊中掉出来的，我们称之为继发性胆管结石。在一些胆囊结石非常多见而原发性胆管结石很少的西方国家，绝大多数胆管结石是继发性的，在我国城市地区这种现象也很普遍。那么为什么有些病人在胆囊切除术后一段时间内又发现了胆管结石呢？可能的原因是：1、切除胆囊时没有发现同时存在继发性胆总管结石；2、患者的胆总管结石确实是新生出来的。这种情况比较少见。但有一点可以肯定，切除有结石的胆囊只会减少胆管长结石的危险，而不是相反。
切除胆囊对人体有什么害处？
首先绝不应轻易切除胆囊，就是说胆囊切除术应该有明确的适应证，只有经过仔细研究，认为保留有病变、有石头的胆囊对病人的危害超过胆囊的生理功能对人体的好处时，才应去做胆囊切除术。切除胆囊后，由于失去了胆囊储存胆汁的功能，人的消化功能在短时间内会受到一定影响，但影响并不大．绝大多数病人会逐渐适应，不会感到有什么异常。从临床看，那些手术前胆囊结石症状轻微，甚或没有症状者，以及手术前胆囊功能基本正常者，手术后容易出现这种消化功能失常；而那些术前症状重，胆囊已经丧失正常功能的人，手术后的消化功能反倒会改善。
得了胆囊结石一定要开刀切除胆囊吗？打孔手术是不是更好些？
回答是不一定。如上所述，胆石症的发病率非常高，有些人确实没有什么明显症状，我们称之为安静结石。对这些人不妨采取观望态度，等待有症状时再说。由于胆囊结石的根本发生原因有两个：一个是肝脏代谢有问题，产生的胆汁易于成石；另一个是胆囊本身有问题。我们现在还没有可靠的治疗这两个问题的手段，因此即使将胆囊中的结石拿出来，用不了多久还会长出新胆石。在现今医学发展的水平下，惟有切除胆囊才能根除胆石症带来的麻烦。这就是为什么胆囊切除术是最可靠的治疗胆石症的手段的原因。有人形象地将此比喻为“砍倒了树，鸟才不会再来”。虽然不符合生理，但却是不得已而为之的事。打孔手术是腹腔镜胆囊切除术的俗称，是年代新兴的手术方式。它与传统的开刀切胆囊在本质上没有不同，所不同的只是开刀的切口较小，病人恢复快，痛苦小，因而深受病人欢迎。可以说绝大多数病人均可以通过这种方法切除胆囊。不过具体到每一位病人，究竟适合用哪种方法，应该由医生做出决定。一般说来，现今的腹腔镜胆囊切除术在安全性及适应证方面仍然比不上开刀手术，特别是那些情况复杂的胆囊结石和有胆道合并症的病人，仍然以开刀手术较为安全。
胆管结石怎么治最好？
胆管结石怎么治最好？我来回答，1、舒肝理气、化瘀通导、疏利扩张、消炎通管等综合作用，使肝内各级分支胆管内壁的瘀积性杂质、稠厚胆汁性结石结晶以及瘀积性毒素等，通导至肠道，排除于体外，从而达到肝内胆管内壁炎症性水肿消除，各级肝内胆管相互打开通道、通畅无阻，在药物的作用下，首先使泥沙样结石、微小结石结晶分解还原为胶原胆汁，随胆汁的流动进入肠道，逐渐排出体外，如此不断清除管道，恢复肝内胆管通畅。
2、在堵塞的肝管旁建立侧枝通道，使淤积的胆汁排出肝脏，从而恢复损伤的肝功能，解除肝细胞水肿、肝萎缩、肝硬化的危险，这也是肝内胆管结石治疗的首要任务。
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