肝内胆管结石的治疗.ppt

The Treatment of Hepatolithiasis
治疗原则(Principle)
主要是手术治疗(Surgical treatment of Hepatolithiasis),原则为尽可能取尽结石、解除胆道狭窄及梗阻,去除结石部位和感染病灶、恢复建立通畅的胆汁引流,防止结石的复发。
1、remove the calculus
2、disengage the biliary obstruction and stenosis
3、elimination of intrahepatic infectious lesions
4、allowing the bile discharge flow
5、prevent the relapse of calculus
adjunctive therapy
非手术治疗(non operation treatment ):
1、应用抗生素( Antibiotics );
2、解痉( Spasmolysis );
3、利胆( Gallbladder );
4、纠正水、电解质及酸碱平衡紊乱(Correct water, electrolyte and acid-base balance disturbance );
5、加强营养支持(Strengthen nutrition support );
6、护肝及纠正凝血功能异常(Liver and correction of coagulation abnormalities)。
手术治疗原则:
解除狭窄和去除病灶为关键
手术方式(Surgery way):
1、高位胆管切开取石(High bile duct incision to take stone);
2、胆肠吻合术(Biliary intestinal anastomosis);
3、肝叶切除( Lobectomy of liver );
4、胆道镜取石(Removal of gallstones by choledochoscope)
High bile duct incision to take stone
最基本的方法
胆肠吻合术( Biliary intestinal anastomosis)
适应症(indication)
1、胆管狭窄充分切开后整形、肝内胆管扩张并肝内胆管结石不能取尽者
2、Oddi括约肌功能散失,肝内胆管结石伴扩张
3、囊性扩张并结石的胆总管或肝总管切除后
4、为建立皮下空肠盲襻
5、胆总管十二指肠吻合后,因肠液或食物反流反复发作胆管炎
1、After bile duct narrow full incision, in the reshaping, the liver in the bile duct expansion and the liver the bile duct stone cannot take
2、Oddi sphincter function disappearing, in the liver the bile duct stone partner expands
3、After cystic expansion and stone choledoch or ductus munis excision
5、After the choledoch duodenum intestines tally, because the intestinal juices or food regurgitation manifest suddenly repeatedly the cholangitis
Roux-en-Y