胆总管结石病的诊疗进展

Progress in Diagnosis and Treatment of Common Bile Duct Stones

摘要: 胆总管结石是指原发或继发于胆总管内的结石，属于胆道系统的常见疾病，可同时伴随胆道梗阻、胆管炎、胰腺炎、胆汁性硬化等严重并发症。临床表现常为寒战、腹痛、高热、休克、神志不清等。随着医疗设备和技术的不断更新，对胆总管结石需要更为精准的诊疗。诊断方面，无创、高精度的影像学技术逐渐取代传统方法，其中MRCP凭借高敏感性和非侵入性成为主要的诊断手段。治疗方面，药物溶石仅适用于胆固醇性小结石，微创技术仍占据主导地位，它克服了传统剖腹手术的缺点，以腹腔镜和内镜治疗为主。在面临解剖结构复杂的患者时达芬奇机器人手术则展现出明显优势。本文就胆总管结石的诊断及治疗两方面进行综述，为临床工作者提供一定的诊疗价值。

Abstract: Biliary tract stones refer to stones originating or developing within the common bile duct, representing a common disorder of the biliary system. These stones may lead to severe complications, such as biliary obstruction, cholangitis, pancreatitis, and biliary sclerosis. Clinical manifestations often include chills, abdominal pain, high fever, shock, and altered mental status. With continuous advancements in medical equipment and technology, more precise diagnostic and therapeutic approaches for choledocholithiasis are required. In diagnosis, non-invasive, high-precision imaging techniques have increasingly replaced traditional methods, with magnetic resonance cholangiopancreatography (MRCP) emerging as the primary modality due to its high sensitivity and non-invasive nature. For treatment, pharmacological litholysis remains limited to cholesterol-based small stones, while minimally invasive techniques dominate clinical practice. These techniques, primarily laparoscopic and endoscopic interventions, overcome the drawbacks of conventional open surgery. In cases involving complex anatomical structures, robotic-assisted surgery (e.g., Da Vinci system) demonstrates significant advantages. This review aims to summarize recent progress in the diagnosis and management of choledocholithiasis, providing clinicians with updated practical insights.