GUIDE 编者按 《肝胆管结石病综合诊疗湖南专家共识(2024版)》(简称“共识”)历时一年多完成,是湖南省肝胆外科几代人数十年的工作经验与研究成果的结晶。共识中的11条推荐意见,内容全面、系统,涵盖肝胆管结石病的定义、病因病理、临床表现、诊断分型、治疗方法选择、手术时机选择、腹腔镜治疗、设备使用、术后随访等;强调根据病情分期和分型选择个体化治疗方案,术中精细操作及术后规范随访以提高治疗效果。共识对推动湖南乃至全国肝胆管结石病的规范化诊疗具有重要意义。 扫码或点击下方链接阅读下载全文 肝胆管结石病综合诊疗湖南专家共识(2024版) 湖南省医学会肝胆外科专业委员会,湖南省健康管理学会加速康复外科专业委员会,湖南省国际医学交流促进会肝胆外科专业委员会,湖南省肝胆胰外科联盟 摘 要 肝胆管结石病是我国中西部地区常见疾病,尤以湖南多见。该病诊治困难、严重影响人民健康。因病情复杂多变,治疗方法繁多、千差万别,疗效不佳,导致患者处在手术、术后结石残留或复发、再手术、结石再残留或再复发的恶性循环当中,最后因胆汁性肝硬化、胆管癌变失去生命。因此,规范肝胆管结石病的诊疗十分必要。湖南省医学会肝胆外科专业委员会、湖南省健康管理学会加速康复外科专业委员会、湖南省国际医学交流促进会肝胆外科专业委员会、湖南省肝胆胰外科联盟组织省内肝胆外科专家共同讨论,撰写肝胆管结石病综合诊疗湖南专家共识,旨在为肝胆管结石病的规范诊疗提供依据和指导。 Hunan expert consensus on comprehensive diagnosis and treatment of hepatolithiasis (2024 edition) Hepatobiliary Surgery Professional Committee of Hunan Medical Association, Professional Committee of Enhanced Recovery After Surgery of Hunan Health Management Association, Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association, Hunan Alliance of Hepatobiliary and Pancreatic Surgery Abstract Hepatolithiasis is a common disease in the central and western regions of our country, especially prevalent in Hunan province. This disease poses significant challenges in diagnosis and treatment, severely impacting public health. Due to the complex and variable nature of the disease, there are numerous and diverse treatment methods, often with unsatisfactory results, leading patients into a vicious cycle of surgery, postoperative stone residue or recurrence, reoperation, stone residue or recurrence again, ultimately resulting in life-threatening complications such as biliary cirrhosis and bile duct cancer. Therefore, it is extremely necessary to standardize the diagnosis and treatment of hepatolithiasis. The Hepatobiliary Surgery Professional Committee of Hunan Medical Association, the Professional Committee of Enhanced Recovery After Surgery of Hunan Health Management Association, the Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association, and the Hunan Alliance of Hepatobiliary and Pancreatic Surgery have organized discussions among experts in hepatobiliary surgery in the province to draft the Hunan expert consensus on comprehensive diagnosis and treatment of hepatolithiasis, aiming to provide guidance and basis for the standardized diagnosis and treatment of hepatolithiasis. 肝胆管结石病是我国中西部地区的多发病,尤以湖南常见。因其病程长、病理变化复杂,临床诊治困难,术后残石率、复发率及再手术率高,晚期可出现肝硬化、胆管癌等并发症,严重危害患者的身体健康[1-2]。湖南省医学会肝胆外科专业委员会、湖南省健康管理学会加速康复外科专业委员会、湖南省国际医学交流促进会肝胆外科专业委员会、湖南省肝胆胰外科联盟组织湖南省内肝胆外科专家共同讨论,总结了我省在肝胆管结石病诊治方面的经验,结合国内外文献,形成共识,旨在规范与指导肝胆管结石病的诊断与治疗。本共识强调术前精准评估和个体化治疗方案的制定,同时强调术中精细操作提高手术质量,提高肝胆管结石病治疗效果。 1 定 义 原发于左右肝管汇合部以上的胆管结石及其引起的多种继发病变,伴或不伴肝外胆管结石均定义为肝胆管结石病[4]。 2 病因、病理生理 2.1 病因 3 临床表现 肝胆管结石病临床表现在不同患者或同一患者的不同时期有较大差别,主要与结石是否引起主要肝管和肝外胆管梗阻、是否合并感染及程度、是否有并发症及类型、是否已进展为终末期肝病有关,可以表现为无任何症状,或仅有轻微腹痛不适,急性炎症期可表现为剧烈腹痛、发热、黄疸,晚期则出现持续性黄疸,顽固性腹水等肝功能衰竭表现。肝胆管结石病患者在漫长的病程中,根据其临床表现可将肝胆管结石病分为急性期、慢性期、终末期。 4 肝胆管结石病的诊断、分型 4.1 诊断 5 肝胆管结石病的治疗 根据患者临床分期选择治疗(图1):急性期先处理急诊情况,待症状控制后再行彻底性手术治疗[25];慢性期可根据分型选择合适的外科手术方案;终末期考虑肝移植治疗。 5.1 急性期肝胆管结石病治疗 6 随 访 一般术后1~3个月进行首次门诊随访。若患者有T管,则行T管造影,如发现胆管结石残留,可经T管窦道胆道镜取石,酌情拔除T管;若无T管,则复查腹部彩超,血常规,肝功能等,必要时复查CT及MRI。此后每半年1次门诊随访,随访检查项目同上。根据结石残留、复发和结石所引起并发症情况,采取口服利胆溶石类药物(如胆宁片)、再次住院手术及其他有创操作治疗等。 《肝胆管结石病综合诊疗湖南专家共识(2024版)》编审委员会名单 利益冲突:所有作者均声明不存在利益冲突。 (在框内向上滑动手指即可浏览全部参考文献) [1]Kim HJ, Kim JS, Joo MK, et al. Hepatolithiasis and intrahepatic cholangiocarcinoma: a review[J]. World J Gastroenterol, 2015, 21(48):13418-13431. doi:10.3748/wjg.v21.i48.13418. [2]中国研究型医院学会肝胆胰外科专业委员会, 国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病微创手术治疗指南(2019版)[J]. 中华消化外科杂志, 2019, 18(5):407-413. doi:10.3760/cma.j.issn.1673-9752.2019.05.001. Hepatobiliary and pancreatic Surgery Professional Committee of China Research Hospital Association, Expert Committee of Public Welfare Scientific Research Program of National Health Commission. Guidelines for minimally invasive surgery for hepatolithiasis (2019 edition)[J]. Chinese Journal of Digestive Surgery, 2019, 18(5):407-413. doi:10.3760/cma.j.issn.1673-9752.2019.05.001. [3]Healthcare Improvement Scotland. Scottish Intercollegiate Guidelines Network (SIGN)[EB/OL]. Available at: http://www./. [4]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):156-161. doi:10.3760/cma.j.issn.1673-9752.2007.02.028. Biliary Surgery Group, Surgery Society of Chinese Medical Association. Guidelines for the diagnosis and treatment of hepatolithiasis[J]. Chinese Journal of Digestive Surgery, 2007, 6(2):156-161. doi:10.3760/cma.j.issn.1673-9752.2007.02.028. [5]Huang MH, Chen CH, Yen CM, et al. Relation of hepatolithiasis to helminthic infestation[J]. J Gastroenterol Hepatol, 2005, 20(1):141-146. doi:10.1111/j.1440-1746.2004.03523.x. [6]Xiao Z, Huang Z, Gao J, et al. The imbalance of biliary microflora in hepatolithiasis[J]. Microb Pathog, 2021, 157:104966. doi:10.1016/j.micpath.2021.104966. [7]Ran X, Yin B, Ma B. Four major factors contributing to intrahepatic stones[J]. Gastroenterol Res Pract, 2017, 2017:7213043. doi:10.1155/2017/7213043. [8]文天夫, 郑光琪. 肝内胆管结石并狭窄的病理生理改变[J]. 实用外科杂志, 1991, 11(4):206-207. Wen TF, Zheng GQ. Pathophysiological changes of intrahepatic bile duct stones complicated with stricture[J]. Chinese Journal of Practical Surgery, 1991, 11(4):206-207. [9]李富宇, 李宁, 蒋力生, 等. 浅谈慢性增生性胆管炎在肝内胆管结石防治中的意义[J]. 中华肝胆外科杂志, 2008, 14(4):225-228. doi:10.3760/cma.j.issn.1007-8118.2008.04.005. Li FY, Li N, Jiang LS, et al. Significance of chronic hypertrophic cholangitis for prevention and treatment of intrahepatic biliary calculi[J]. Chinese Journal of Hepatobiliary Surgery, 2008, 14(4):225-228. doi:10.3760/cma.j.issn.1007-8118.2008.04.005. [10]李永国. 肝内胆管结石的并发症及其防治[J]. 中国实用外科杂志, 2000, 20(9):524-525. doi:10.3321/j.issn:1005-2208.2000.09.007. Li YG. Complications and prevention of intrahepatic bile duct stones[J]. Chinese Journal of Practical Surgery, 2000, 20(9):524-525. doi:10.3321/j.issn:1005-2208.2000.09.007. [11]黄晓强. 肝胆管结石病合并胆管炎及肝脓肿的诊治[J]. 中国实用外科杂志, 2004, 24(2):74-75. doi:10.3321/j.issn:1005-2208.2004.02.007. Huang XQ. Diagnosis and treatment of hepatolithiasis complicated with cholangitis and liver abscess[J]. Chinese Journal of Practical Surgery, 2004, 24(2):74-75. doi:10.3321/j.issn:1005-2208.2004.02.007. [12]易为民, 蒋波, 周海兰, 等. 肝胆管结石合并支气管胆瘘35例诊治经验[J]. 中华肝胆外科杂志, 2012, 18(2):115-117. doi:10.3760/cma.j.issn.1007-8118.2012.02.010. Yi WM, Jiang B, Zhou HL, et al. Diagnosis and treatment of hepatolithiasis complicated by bronchobiliary fistula: a study on 35 patients[J]. Chinese Journal of Hepatobiliary Surgery, 2012, 18(2):115-117. doi:10.3760/cma.j.issn.1007-8118.2012.02.010. [13]田伏洲, 陈涛, 李旭, 等. 肝胆管结石合并胆道出血的诊断及治疗[J]. 中国实用外科杂志, 2004, 24(2):80-81. doi:10.3321/j.issn:1005-2208.2004.02.011. Tian FZ, Chen T, Li X, et al. Diagnosis and management of hepatolithiasis complicated with hernobilia[J]. Chinese Journal of Practical Surgery, 2004, 24(2):80-81. doi: 10.3321/j.issn:1005-2208.2004.02.011. [14]吴金术, 彭创, 谭正, 等. 肝内胆管结石并肝萎缩肥大征32例的诊治[J]. 中华普通外科杂志, 2017, 32(10):839-842. doi:10.3760/cma.j.issn.1007-631X.2017.10.012. Wu JS, Peng C, Tan Z, et al. Diagnosis and treatment of intrahepatic stone complicated with atrophy-hypertrophy complex[J]. Chinese Journal of General Surgery, 2017, 32(10):839-842. doi:10.3760/cma.j.issn.1007-631X.2017.10.012. [15]陈亚进, 张贺云. 肝胆管结石合并门静脉高压症诊治对策[J]. 中国实用外科杂志, 2016, 36(1):55-57. doi:10.7504/CJPS.ISSN1005-2208.2016.01.17. Chen YJ, Zhang HY. Diagnosis and management strategies of hepatolithiasis complicated with portal hypertension[J]. Chinese Journal of Practical Surgery, 2016, 36(1):55-57. doi:10.7504/CJPS.ISSN1005-2208.2016.01.17. [16]闫朝岐, 杨维良. 门静脉海绵样变的临床诊治现状[J]. 中国普通外科杂志, 2008, 17(6):605-607. doi:10.3969/j.issn.1005-6947.2008.06.021. Yan CQ, Yang WL. Present status in clinical diagnosis and treatment of cavernomatous change of portal vein[J]. Chinese Journal of General Surgery, 2008, 17(6):605-607. doi:10.3969/j.issn.1005-6947.2008.06.021. [17]任克, 张鑫. 肝胆管结石影像学诊断技术选择及评价[J]. 中国实用外科杂志, 2016, 36(3):264-268. doi:10.7504/CJPS.ISSN1005-2208.2016.03.03. Ren K, Zhang X. Selection and evaluation of different imaging technology for hepatolithiasis[J]. Chinese Journal of Practical Surgery, 2016, 36(3):264-268. doi:10.7504/CJPS.ISSN1005-2208.2016.03.03. [18]中华医学会超声医学分会介入诊疗学组. 超声引导经皮经肝胆管穿刺置管引流术中国专家共识(2023版)[J]. 中华超声影像学杂志, 2023, 32(5):369-376. doi:10.3760/cma.j.cn131148-20230123-00046. Interventional Diagnosis and Treatment Group, Chinese Society of Ultrasound Medicine. Chinese expert consensus of ultrasound-guided percutaneous transhepatic biliary drainage(2023 edition)[J]. Chinese Journal of Ultrasonography, 2023, 32(5):369-376. doi:10.3760/cma.j.cn131148-20230123-00046. [19]中华医学会消化内镜学分会ERCP学组, 中国医师协会消化医师分会胆胰学组, 国家消化系统疾病临床医学研究中心. 中国ERCP指南(2018版)[J]. 中华消化内镜杂志, 2018, 35(11):777-813. doi:10.3760/cma.j.issn.1007-5232.2018.11.001. ERCP Group, Chinese Society of Digestive Endoscopology Biliopancreatic Group, Chinese Association of Gastroenterologist and Hepatologist National Clinical Research Center for Digestive Diseases. Chinese guidelines for ERCP (2018)[J]. Chinese Journal of Digestive Endoscopy, 2018, 35(11):777-813. doi:10.3760/cma.j.issn.1007-5232.2018.11.001. [20]中华医学会数字医学分会, 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会, 等. 肝胆管结石三维可视化精准诊治专家共识(2019版)[J]. 中国实用外科杂志, 2019, 39(10):1001-1009. doi:10.19538/j.cjps.issn1005-2208.2019.10.01. Chinese Society of Digital Medicine, Biliary Surgery Group of Chinese Surgical Society, Chinese Committee of Biliary Surgeons, et al. Expert consensus on three-dimensional visualization and accurate diagnosis and treatment of hepatolithiasis (2019 edition)[J]. Chinese Journal of Practical Surgery, 2019, 39(10):1001-1009. doi:10.19538/j.cjps.issn1005-2208.2019.10.01. [21]肖彦, 周磊, 成伟, 等. 术中多影像融合介入导航系统在复杂肝胆管结石病诊断与治疗中的应用价值[J]. 中华消化外科杂志, 2020, 19(1):99-105. doi:10.3760/cma.j.issn.1673-9752.2020.01.016. Xiao Y, Zhou L, Cheng W, et al. Application value of real-time virtual sonography in diagnosis and treatment of complicated hepatolithiasis[J]. Chinese Journal of Digestive Surgery, 2020, 19(1):99-105. doi:10.3760/cma.j.issn.1673-9752.2020.01.016. [22]吴金术, 彭创. 肝胆管结石综合诊治体系[J]. 中国医师杂志, 2007, 9(9):1153-1155. doi:10.3760/cma.j.issn.1008-1372.2007.09.001. Wu JS, Peng C. Comprehensive diagnosis and treatment system of hepatolithiasis[J]. Journal of Chinese Physician, 2007, 9(9):1153-1155. doi:10.3760/cma.j.issn.1008-1372.2007.09.001. [23]吴金术. 临床胆石病学[M]. 长沙: 湖南科学技术出版社, 1998. Wu JS. Clinial cholelithiology[M]. Changsha: Hunan Science & Technology Press, 1998. [24]Abou-Khalil JE, Bertens KA. Embryology, anatomy, and imaging of the biliary tree[J]. Surg Clin North Am, 2019, 99(2):163-174. doi:10.1016/j.suc.2018.12.005. [25]赖佳明, 梁力建, 李绍强, 等. 肝胆管结石手术时机的选择[J]. 中国实用外科杂志, 2003, 23(6):335-337. doi:10.3321/j.issn: 1005-2208.2003.06.010. Lai JM, Liang LJ, Li SQ, et al. Surgical opportunity for hepatolithiasis[J]. Chinese Journal of Practical Surgery, 2003, 23(6):335-337. doi:10.3321/j.issn: 1005-2208.2003.06.010. [26]李绍强, 梁力建, 彭宝岗, 等. 肝内胆管结石合并急性胆管炎的肝切除时机[J]. 中华外科杂志, 2006, 44(23):1607-1609. doi:10.3760/j: issn: 0529-5815.2006.23.008. Li SQ, Liang LJ, Peng BG, et al. The timing of hepatectomy for hepatolithiasis complicated with acute cholangitis[J]. Chinese Journal of Surgery, 2006, 44(23):1607-1609. doi:10.3760/j: issn: 0529-5815.2006.23.008. [27]马敏, 周中银. 胆道出血的临床现状探究[J]. 临床肝胆病杂志, 2019, 35(2):438-440. doi:10.3969/j.issn.1001-5256.2019.02.044. Ma M, Zhou ZY. Current status of clinical research on hematobilia[J]. Journal of Clinical Hepatology, 2019, 35(2):438-440. doi:10.3969/j.issn.1001-5256.2019.02.044. [28]中华医学会外科学分会胆道外科学组. 急性胆道系统感染的诊断和治疗指南(2021版)[J]. 中华外科杂志, 2021, 59(6):422-429. doi:10.3760/cma.j.cn112139-20210421-00180. Biliary Surgery Group of Chinese Surgical Society. Guidelines for diagnosis and treatment of acute biliary tract infections(2021)[J]. Chinese Journal of Surgery, 2021, 59(6):422-429. doi:10.3760/cma.j.cn112139-20210421-00180. [29]Miura F, Okamoto K, Takada T, et al. Tokyo Guidelines 2018: initial management of acute biliary infection and flowchart for acute cholangitis[J]. J Hepatobiliary Pancreat Sci, 2018, 25(1):31-40. doi:10.1002/jhbp.509. [30]曾永毅, 黄新辉. 肝胆管结石合并胆道感染的诊断及处理[J]. 中国实用外科杂志, 2016, 36(3):295-299. doi:10.7504/CJPS.ISSN1005-2208.2016.03.12. Zeng YY, Huang XH. Diagnosis and treatment of hepatolithiasis combined with biliary infection[J]. Chinese Journal of Practical Surgery, 2016, 36(3):295-299. doi:10.7504/CJPS.ISSN1005-2208.2016.03.12. [31]中华医学会急诊医学分会. 细菌性肝脓肿诊治急诊专家共识[J]. 中华急诊医学杂志, 2022, 31(3):273-280. doi:10.3760/cma.j.issn.1671-0282.2022.03.003. Society of Emergency Medicine, Chinese Medical Association. Expert consensus on emergency diagnosis and treatment of pyogenic liver abscess[J]. Chinese Journal of Emergency Medicine, 2022, 31(3):273-280. doi:10.3760/cma.j.issn.1671-0282.2022.03.003. [32]全志伟, 张一楚. 胆道出血的定位诊断及处理[J]. 中国实用外科杂志, 1996, 16(6):323-325. Quan ZW, Zhang YC. Localization, diagnosis and treatment of biliary tract bleeding[J]. Chinese Journal of Practical Surgery, 1996, 16(6):323-325. [33]田成武, 朱华文, 曲明, 等. 胆道大出血的造影诊断及介入栓塞治疗[J]. 中华肝胆外科杂志, 2002, 8(10):589-591. doi:10.3760/cma.j.issn.1007-8118.2002.10.004. Tian CW, Zhu HW, Qu M, et al. Angiographic diagnosis and interventional embolization for massive hemobilia[J]. Chinese Journal of Hepatobiliary Surgery, 2002, 8(10):589-591. doi:10.3760/cma.j.issn.1007-8118.2002.10.004. [34]中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021)[J]. 浙江实用医学, 2021, 26(6):511-519. doi:10.16794/j.cnki.cn33-1207/r.2021.06.003. Pancreatic Surgery Group, Surgical Society of Chinese Medical Association. Guidelines for diagnosis and treatment of acute pancreatitis in China (2021)[J]. Zhejiang Practical Medicine, 2021, 26(6):511-519. doi:10.16794/j.cnki.cn33-1207/r.2021.06.003. [35]黄志强. 黄志强胆道外科[M]. 济南: 山东科学技术出版社, 1998. Huang ZQ. Biliary surgery in Huang Zhiqiang[M]. Jinan: Shandong Science & Technology Press, 1998. [36]吴金术, 彭创, 李云峰. 浅谈目前对肝胆管结石的处理[J]. 中国医师杂志, 2015, 17(3):321-323. doi:10.3760/cma.j.issn.1008-1372.2015.03.001. Wu JS, Peng C, Li YF. Discussion on the treatment of hepatolithiasis at present[J]. Journal of Chinese Physician, 2015, 17(3): 321-323. doi:10.3760/cma.j.issn.1008-1372.2015.03.001. [37]Park JS, Jeong S, Lee DH, et al. Risk factors for long-term outcomes after initial treatment in hepatolithiasis[J]. J Korean Med Sci, 2013, 28(11):1627-1631. doi:10.3346/jkms.2013.28.11.1627. [38]湖南省卫生健康委员会加速康复外科试点工作指导与评价专家委员会, 湖南省医学会肝胆外科专业委员会, 湖南省健康管理学会加速康复外科专业委员会, 等. 肝胆胰外科疾病加速康复外科临床路径湖南专家共识(2022 版)[J]. 中国普通外科杂志, 2022, 31(7):847-859. doi:10.7659/j.issn.1005-6947.2022.07.001. Expert Committee of Committee of Hunan Provincial Health Commission for Guidance and Evaluation of Pilot Work of Enhanced Recovery After Surgery, Hepatobiliary Surgery Professional Committee of Hunan Medical Association, Professional Committee of Enhanced Recovery After Surgery of Hunan Health Management Association, et al. Hunan expert consensus on clinical pathway for enhanced recovery after surgery of hepatopancreatobiliary surgical diseases (2022 version)[J]. China Journal of General Surgery, 2022, 31(7):847-859. doi:10.7659/j.issn.1005-6947.2022.07.001. [39]吴金术. 肝胆管盆式内引流术治疗肝胆管结石的手术方法[J]. 中华普通外科杂志, 2001, 16(6):378. doi:10.3760/j.issn: 1007-631X.2001.06.027. Wu JS. Surgical method of treating hepatolithiasis by intrahepatic drainage with hepatobiliary basin[J]. Chinese Journal of General Surgery, 2001, 16(6):378. doi:10.3760/j.issn: 1007-631X.2001.06.027. [40]中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科学组. 围肝门区域外科技术临床应用路径中国专家共识(2020版)[J]. 中国实用外科杂志, 2020, 40(6):626-633. doi:10.19538/j.cjps.issn1005-2208.2020.06.02. Biliary Surgery Group of Chinese Surgical Society, Chinese Committee of Biliary Surgeons. Chinese expert consensus on the clinical application path of perihilar surgical technique (2020 edition)[J]. China Industrial Economics, 2020, 40(6):626-633. doi:10.19538/j.cjps.issn1005-2208.2020.06.02. [41]刘剑鸣, 易为民, 彭创, 等. 肝方叶切除联合肝门胆管高位劈开整形在肝门胆管狭窄合并结石中的应用[J]. 中国普通外科杂志, 2020, 29(2):198-203. doi:10.7659/j.issn.1005-6947.2020.02.011. Liu JM, Yi WM, Peng C, et al. Application of quadrate lobectomy combined with high-level splitting and plasty of the hilar bile ducts in treatment of hilar bile duct stricture with hepatolithiasis[J]. China Journal of General Surgery, 2020, 29(2):198-203. doi:10.7659/j.issn.1005-6947.2020.02.011. [42]彭创, 黄甫, 孙增鹏, 等. 内吻合在肝内胆管结石合并胆管口狭窄治疗中的应用[J]. 中华普通外科杂志, 2020, 35(6):471-475. doi:10.3760/cma.j.cn113855-20190911-00536. Peng C, Huang F, Sun ZP, et al. Internal anastomosis in the treatment of intrahepatic biliary calculi combined with strictured openings of biliary tracts[J]. Chinese Journal of General Surgery, 2020, 35(6):471-475. doi:10.3760/cma.j.cn113855-20190911-00536. [43]孙增鹏, 谭志国, 彭创, 等. 循纤维化边界行解剖性肝切除在肝胆管结石并肝萎缩肥大征治疗中的应用[J]. 中华普通外科杂志, 2021, 36(7):499-502. doi:10.3760/cma.j.cn113855-20200225-00123. Sun ZP, Tan ZG, Peng C, et al. Fibrotic border guided anatomical hepatectomy in the treatment of hepatolithiasis complicated with atrophy-hypertrophy complex[J]. Chinese Journal of General Surgery, 2021, 36(7):499-502. doi:10.3760/cma.j.cn113855-20200225-00123. [44]吴金术. 如何掌握胆肠内引流指征[J]. 肝胆外科杂志, 2006, 14(1):71. doi:10.3969/j.issn.1006-4761.2006.01.030. Wu JS. How to master the indications of biliary and intestinal drainage[J]. Journal of Hepatobiliary Surgery, 2006, 14(1):71. doi:10.3969/j.issn.1006-4761.2006.01.030. [45]中国研究型医院学会肝胆胰外科专业委员会, 国家卫生健康委员会公益性行业科研专项专家委员会. 肝胆管结石病胆肠吻合术应用专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(5):414-418. doi:10.3760/cma.j.issn.1673-9752.2019.05.002. Chinese Research Hospital Association, Society for Hepatopancreatobiliary Surgery, Expert Committee of Public Welfare Scientific Research Program of National Health Commission. Expert consensus on application of choledochojejunostomy in hepatolithiasis (2019 edition)[J]. Chinese Journal of Digestive Surgery, 2019, 18(5):414-418. doi:10.3760/cma.j.issn.1673-9752.2019.05.002. [46]陈志宇, 别平. 胆肠吻合在肝胆管结石治疗中的合理应用[J]. 中国实用外科杂志, 2016, 36(3):280-283. doi:10.7504/CJPS.ISSN1005-2208.2016.03.07. Chen ZY, Bie P. Reasonable application of bilioenterostomy in the treatment of hepatolithiasis[J]. Chinese Journal of Practical Surgery, 2016, 36(3):280-283. doi:10.7504/CJPS.ISSN1005-2208.2016.03.07. [47]Feng LB, Xia D, Yan LN. Liver transplantation for hepatolithiasis: is terminal hepatolithiasis suitable for liver transplantation?[J]. Clin Transplant, 2016, 30(6):651-658. doi:10.1111/ctr.12731. [48]安伟, 刘双, 周敬强, 等. Ⅱa型肝胆管结石病外科治疗策略分析[J]. 中华肝胆外科杂志, 2017, 23(6):414-416. doi:10.3760/cma.j.issn.1007-8118.2017.06.014. An W, Liu S, Zhou JQ, et al. Surgical strategies for type Ⅱa hepatolithiasis[J]. Chinese Journal of Hepatobiliary Surgery, 2017, 23(6):414-416. doi:10.3760/cma.j.issn.1007-8118.2017.06.014. [49]中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科医师委员会. 胆道镜在肝胆管结石病诊断与治疗中的应用专家共识(2019版)[J]. 中华消化外科杂志, 2019, 18(7):611-615. doi:10.3760/cma.j.issn.1673-9752.2019.07.001. Biliary Surgery Group of Chinese Surgical Society, Chinese Committee of Biliary Surgeons. Expert consensus on application of choledochoscope in diagnosis and treatment of hepatolithiasis (2019 edition)[J]. Chinese Journal of Digestive Surgery, 2019, 18(7):611-615. doi:10.3760/cma.j.issn.1673-9752.2019.07.001. [50]陈晨, 李业荣, 吴金术, 等. 输尿管硬镜联合钬激光结合高位胆管切开治疗复杂肝胆管结石[J]. 世界华人消化杂志, 2021, 29(12):655-661. doi:10.11569/wcjd.v29.i12.655. Chen C, Li YR, Wu JS, et al. Rigid ureteroscopy and holmium laser combined with high bile duct incision to treat complex hepatic calculus[J]. World Chinese Journal of Digestology, 2021, 29(12):655-661. doi:10.11569/wcjd.v29.i12.655. [51]李佳, 李国光, 胡脉涛, 等. 围肝门外科技术治疗弥漫型肝胆管结石病的临床疗效[J]. 中华消化外科杂志, 2021, 20(8):883-889. doi:10.3760/cma.j.cn115610-20210810-00389. Li J, Li GG, Hu MT, et al. Clinical efficacy of perihilar surgical techniques for diffuse hepatolithiasis[J]. Chinese Journal of Digestive Surgery, 2021, 20(8):883-889. doi:10.3760/cma.j.cn115610-20210810-00389. [52]朱斯维, 尹新民. 肝胆管结石腔镜手术的决策与要点[J]. 肝胆外科杂志, 2021, 29(2):81-83. doi:10.3969/j.issn.1006-4761.2021.02.002. Zhu SW, Yin XM. Decision-making and key points of endoscopic surgery for hepatolithiasis[J]. Journal of Hepatobiliary Surgery, 2021, 29(2):81-83. doi:10.3969/j.issn.1006-4761.2021.02.002. [53]李云峰, 尹新民. 复杂肝胆管结石腹腔镜治疗的难点与对策[J]. 肝胆外科杂志, 2020, 28(1):1-4. doi:10.3969/j.issn.1006-4761.2020.01.002. Li YF, Yin XM. Difficulties and countermeasures of laparoscopic treatment for complicated hepatolithiasis[J]. Journal of Hepatobiliary Surgery, 2020, 28(1):1-4. doi:10.3969/j.issn.1006-4761.2020.01.002. [54]中国肝胆外科术中超声学院. 术中超声在胆道外科的应用中国专家共识(2022版)[J]. 中华肝胆外科杂志, 2023, 29(1):5-14. doi:10.3760/cma.j.cn113884-20221215-00465. Chinese College of Intraoperative Ultrasound of Hepatobiliary Surgery. Chinese expert consensus on the application of intraoperative ultrasound in biliary tract surgery (2022 edition)[J]. Chinese Journal of Hepatobiliary Surgery, 2023, 29(1):5-14. doi:10.3760/cma.j.cn113884-20221215-00465. [55]肖震宇, 杨藩, 童兵, 等. 牛磺熊去氧胆酸预防肝胆管结石术后复发的随机对照研究[J]. 中国微创外科杂志, 2015, 15(10):891-893. doi:10.3969/j.issn.1009-6604.2015.10.008. Xiao ZY, Yang F, Tong B, et al. A randomized controlled study on tauroursodeoxycholic acid for the prevention of postoperative relapse of hepatic Calculus[J]. Chinese Journal of Minimally Invasive Surgery, 2015, 15(10):891-893. doi:10.3969/j.issn.1009-6604.2015.10.008. [56]王平, 曹亚文, 孙北望, 等. 三维可视化技术引导的经皮经肝Ⅰ期胆道造瘘取石术在复杂肝内胆管结石中的应用[J]. 中华肝胆外科杂志, 2021, 27(7):509-512. doi:10.3760/cma.j.cn113884-20210410-00133. Wang P, Cao YW, Sun BW, et al. Three-dimensional visualization technology in one-stage establishment of a percutaneous transhepatic biliary tract in treatment of complex hepatolithiasis[J]. Chinese Journal of Hepatobiliary Surgery, 2021, 27(7):509-512. doi:10.3760/cma.j.cn113884-20210410-00133. [57]中国研究型医院学会肝胆胰外科专业委员会. 肝胆管结石病经皮经肝取石手术应用指南(2021版)[J]. 中华肝胆外科杂志, 2022, 28(1):7-14. doi:10.3760/cma.j.cn113884-20211015-00336. Chinese Research Hospital Association, Society for Hepatopancreatobiliary Surgery. Guideline for application of percutaneous transhepatic choledochoscopic lithotripsy in hepatolithiasis (2021 edition)[J]. Chinese Journal of Hepatobiliary Surgery, 2022, 28(1):7-14. doi:10.3760/cma.j.cn113884-20211015-00336. [58]陈少秋, 王蕾, 米杨, 等. 经皮肝胆管穿刺碎石术后胆漏并发症的诊治与预防[J]. 肝胆胰外科杂志, 2021, 33(6):362-364. doi:10.11952/j.issn.1007-1954.2021.06.010. Chen SQ, Wang L, Mi Y, et al. Diagnosis, treatment and prevention of bile leakage after percutaneous transhepatic choledocholithotomy[J]. Journal of Hepatopancreatobiliary Surgery, 2021, 33(6):362-364. doi:10.11952/j.issn.1007-1954.2021.06.010. [59]Jeng KS, Sheen IS, Yang FS. Vascular complications in percutaneous transhepatic management of complicated hepatolithiasis with difficult intrahepatic biliary strictures: are they avoidable?[J]. Surg Laparosc Endosc Percutan Tech, 2002, 12(2):82-87. doi:10.1097/00129689-200204000-00002. [60]卢嘉胤, 陈少秋, 蒋超, 等. 经皮肝胆管穿刺碎石术胆道出血并发症的诊治与预防[J]. 中国医师杂志, 2022, 24(11):1616-1619. doi:10.3760/cma.j.cn431274-20220412-00311. Lu JY, Chen SQ, Jiang C, et al. Diagnosis, treatment and prevention of biliary hemorrhage after percutaneous transhepatic choledochoscopic lithotomy[J]. Journal of Chinese Physician, 2022, 24(11):1616-1619. doi:10.3760/cma.j.cn431274-20220412-00311. [61]张智桦, 戴金, 王蕾, 等. 经皮肝胆管穿刺碎石术中水电解质紊乱预防初探[J]. 肝胆胰外科杂志, 2020, 32(10):624-626. doi:10.11952/j.issn.1007-1954.2020.10.010. Zhang ZH, Dai J, Wang L, et al. Preliminary study on prevention of water-electrolyte disturbance in percutaneous transhepatic bile duct puncture lithotripsy[J]. Journal of Hepatopancreatobiliary Surgery, 2020, 32(10):624-626. doi:10.11952/j.issn.1007-1954.2020.10.010. (本文编辑 姜晖) 本文引用格式:湖南省医学会肝胆外科专业委员会,湖南省健康管理学会加速康复外科专业委员会,湖南省国际医学交流促进会肝胆外科专业委员会,等. 肝胆管结石病综合诊疗湖南专家共识(2024版)[J]. 中国普通外科杂志, 2024, 33(2):153-167. doi:10.7659/j.issn.1005-6947.2024.02.001 Cite this article as: Hepatobiliary Surgery Professional Committee of Hunan Medical Association, Professional Committee of Enhanced Recovery After Surgery of Hunan Health Management Association, Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association, et al. Hunan expert consensus on comprehensive diagnosis and treatment of hepatolithiasis (2024 edition)[J]. Chin J Gen Surg, 2024, 33(2):153-167. doi:10.7659/j.issn.1005-6947.2024.02.001 |
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