肝内胆管结石病诊断与治疗的研究进展

Research Progress in the Diagnosis and Treatment of Intrahepatic Bile Duct Stones

摘要: 肝内胆管结石是指在左右肝管汇合部以上存在结石，好发于亚洲，近一个世纪以来，由于人口迁徙，其全球发病率呈上升趋势，其病因复杂，治疗难度大，术后复发率高、并发症多，严重影响患者的生活质量，主要病理生理机制涉及胆管炎、胆汁感染和胆道狭窄，形成一个自我维持的疾病循环，常表现为反复发作的细菌感染。目前外科手术是治疗肝内胆管结石的主要方式，经皮经肝胆道镜取石术(percutaneous transhepatic choledochoscopic lithotripsy, PTCSL)等内镜技术的发展为肝内胆管结石患者带来了更优质的治疗。随着肝胆管结石病病因研究的逐步深入、影像技术的不断革新以及治疗手段的日益多元化，针对该疾病的治疗愈发需要制定个体化、系统化的方案。本文将从肝胆管结石病的流行病学特征、病理发生机制、临床诊断方法及治疗策略等多个维度展开综述，以期为该疾病的临床治疗提供参考依据。

Abstract: Intrahepatic bile duct stones refer to the presence of stones above the confluence of the left and right hepatic ducts. They are more common in Asia. Over the past century, due to population migration, the global incidence rate has been on the rise. The causes are complex, the treatment is difficult, the postoperative recurrence rate is high, and there are many complications, which seriously affect the quality of life of patients. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary striction. It forms a self-sustaining disease cycle, often manifested as recurrent bacterial infections. At present, surgical operation is the main method for treating Intrahepatic bile duct stones. The development of endoscopic techniques such as percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) has brought better treatment options for patients with intrahepatic bile duct stones. The development of endoscopic techniques such as PTCSL has brought better treatment options for patients with Intrahepatic bile duct stones. With the gradual deepening of research on the etiology of hepatobiliary duct stones, the continuous innovation of imaging technology and the increasing diversification of treatment methods, individualized and systematic treatment plans for this disease are increasingly needed. This article will conduct a review from multiple dimensions such as the epidemiological characteristics, pathological occurrence mechanism, clinical diagnostic methods and treatment strategies of hepatobiliary duct stones, with the aim of providing a reference basis for the clinical treatment of this disease.