隐匿性胆总管结石诊断与治疗的新进展

王超; 徐锋; 刘晓琳; 戴朝六

doi:10.3969/j.issn.1001-5256.2017.07.042

隐匿性胆总管结石诊断与治疗的新进展

DOI: 10.3969/j.issn.1001-5256.2017.07.042

中国医科大学附属盛京医院肝胆脾外科

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中图分类号: R575.7
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出版历程
- 收稿日期: 2016-11-21
- 出版日期: 2017-07-20

Latest advances in diagnosis and treatment of occult common bile duct stones

Department of Hepatobiliary and Splenic Surgery, Shengjing Hospital of China Medical University

摘要

摘要: 隐匿性胆总管结石临床上无症状,如不及时诊断和处理,可诱发胆囊切除术后不明原因腹痛,或是胆源性胰腺炎、急性胆管炎等严重并发症而危及生命。选择合适的诊断及治疗方式可降低术后并发症、节约医疗资源并可能减少医患纠纷。简述了隐匿性胆总管结石的诊断与治疗新进展,包括影像学检查(腹部超声、CT、磁共振胰胆管造影、超声内镜、经内镜逆行胰胆管造影、术中胆道造影、术中腹腔镜超声、胆管腔内超声及术中胆道镜)的基本特点和诊断效能,不同治疗方式(十二指肠乳头括约肌切开术、腹腔镜胆总管探查术、开腹胆总管探查、内镜下球囊扩张术、液电碎石法、体外冲击波碎石法、结石溶解法及激光碎石法)的治疗效果。指出隐匿性胆总管结石的诊疗应根据风险分层区别对待。中层以上风险者应尽可能完善超声内镜或磁共振胰胆管造影检查,其结果对术式的选择至关重要。治疗方式上应根据实际条件酌情选择腹腔镜胆总管探查术或经内镜逆行胰胆管造影/十二指肠乳头括约肌切开术。
- 胆总管结石 /
- 诊断 /
- 治疗 /
- 综述
Abstract: Occult common bile duct stones have no clinical symptoms and if it is not diagnosed or treated in time, it can cause unexplained abdominal pain after cholecystectomy or serious complications such as biliary pancreatitis and acute cholangitis, which may threaten patients' lives.Proper diagnosis and treatment modalities can reduce postoperative complications, save medical resources, and reduce medical disputes.This article introduces the latest advances in the diagnosis and treatment of occult common bile duct stones, including the features and diagnostic efficacy of imaging examinations (abdominal ultrasound, computed tomography, magnetic resonance cholangiopancreatography (MRCP) , endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP) , intraoperative cholangiography, intraoperative laparoscopic ultrasonography, intraductal ultrasonography, and intraoperative choledochoscopy) , as well as the effect of treatment modalities (endoscopic sphincterotomy (EST) , laparoscopic common bile duct exploration (LCBDE) , open common bile duct exploration, endoscopic papillary balloon dilatation, electrohydaulic lithotripsy, extracorporeal shockwave lithotripsy, litholysis, and laser lithotripsy) .It is pointed out that the diagnosis and treatment of occult common bile duct stones should be treated differently according to risk stratification.Endoscopic ultrasonography or MRCP should be performed for patients with moderate risks or above, and their results are critical to the choice of surgical procedure.For treatment modality, LCBDE or ERCP/EST should be selected according to patients' actual conditions.
- choledocholithiasis /
- diagnosis /
- therapy /
- review

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