胆管树理念在肝内胆管结石微创手术中的应用

doi:10.16139/j.1007-9610.2025.02.05

外科理论与实践 ›› 2025, Vol. 30 ›› Issue (2): 120-124.doi: 10.16139/j.1007-9610.2025.02.05

胆管树理念在肝内胆管结石微创手术中的应用

李敬东(), 黄徐建, 李强, 朱建交

川北医学院附属医院肝胆外一科，川北医学院肝胆胰肠疾病研究所，四川省消化系统疾病临床医学研究中心，四川南充 637000

收稿日期:2025-03-05 出版日期:2025-03-25 发布日期:2025-07-07
通讯作者: 李敬东，E-mail：lijingdong358@126.com
基金资助:
四川省科技计划项目(2024YFHZ0052)

Application of the bile duct tree concept in minimally invasive surgery for intrahepatic bile duct stones

LI Jingdong(), HUANG Xujian, LI Qiang, ZHU Jianjiao

Department of Hepatobiliary Surgery Ⅰ, Affiliated Hospital of North Sichuan Medical College; Institute of Hepato-Biliary-Pancreatic-Intestinal Disease, North Sichuan Medical College; Sichuan Clinical Research Center for Digestive Diseases, Si-chuan Nanchong 637000, China

Received:2025-03-05 Online:2025-03-25 Published:2025-07-07

摘要/Abstract

摘要：

肝内胆管结石作为我国肝胆外科领域的高发疾病，其临床治疗面临多重挑战。传统解剖性肝切除术式难以实际实施以及胆管狭窄矫正效果受限是结石易残留与复发的核心机制。针对这一临床难题，胆道外科已逐渐发展出以肝静脉三维走行特征联合病理性胆管树分布模式为导向的肝内胆管结石病的精准、微创切除理念。在技术实施层面，需建立规范化操作体系，包括腹腔镜下精准肝实质离断、肝门部胆管成形重建，同时结合术中超声、吲哚菁绿(ICG)荧光染色标记、多镜联合取石等辅助技术。

关键词: 胆石症, 肝脏疾病, 胆管树, 腹腔镜技术

Abstract:

Intrahepatic bile duct stones, as a prevalent disease in the field of hepatobiliary surgery in China, present multiple challenges in clinical management. The core factors contributing to stone retention and recurrence lie in the practical difficulties of implementing traditional anatomic hepatectomy and the limited efficacy in correcting biliary strictures. In response to this clinical dilemma, the specialty of biliary surgery has progressively developed a precise and minimally invasive resection concept guided by three-dimensional hepatic venous anatomy combined with lesioned bile duct tree distribution patterns. At the technical implementation level, it is imperative to establish a standardized operative system encompassing laparoscopic precision parenchymal transection, hilar bile duct plastic reconstruction, along with auxiliary techniques such as intraoperative ultrasound, indocyanine green fluorescence staining guidance, and multi-endoscopic combined stone extraction approaches.

Key words: Hepatolithiasis, Liver diseases, Bile duct tree, Laparoscopic technique

中图分类号:

李敬东, 黄徐建, 李强, 朱建交. 胆管树理念在肝内胆管结石微创手术中的应用[J]. 外科理论与实践, 2025, 30(2): 120-124.

LI Jingdong, HUANG Xujian, LI Qiang, ZHU Jianjiao. Application of the bile duct tree concept in minimally invasive surgery for intrahepatic bile duct stones[J]. Journal of Surgery Concepts & Practice, 2025, 30(2): 120-124.

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参考文献 13

[1]	MOTTA R V, SAFFIOTI F, MAVROEIDIS V K. Hepatolithiasis: epidemiology, presentation, classification and management of a complex disease[J]. World J Gastroenterol, 2024, 30(13):1836-1850.
[2]	王坚. 对肝内胆管结石规范性治疗的认识与思考[J]. 中国普通外科杂志, 2025, 34(2):238-244.
	WANG J. Understanding and reflection on the standar-dized treatment of hepatolithiasis[J]. Chin J Gen Surg, 2025, 34(2):238-244.
[3]	董家鸿, 叶晟. 我国肝胆管结石病治疗理念及模式的变迁[J]. 中国实用外科杂志, 2016, 36(3):261-263.
	DONG J H, YE S. Evolution and development of philosophy and paradigm in treatment for hepatolithiasis[J]. Chin J Pract Surg, 2016, 36(3):261-263.
[4]	黄龙, 陈实. 腹腔镜循肝中静脉半肝切除联合经肝管取石术在复杂肝内胆管结石中的应用[J]. 中国实用外科杂志, 2024, 44(8):941-946.
	HUANG L, CHEN S. The application of laparoscopic middle hepatic vein-guided anatomical hepatectomy combined with transhepatic duct lithotomy to the treatment of complex hepatolithiasis[J]. Chin J Pract Surg, 2024, 44(8):941-946.
[5]	黄徐建, 何毅, 何理, 等. 腹腔镜和开腹肝切除术治疗肝内胆管结石安全性和效果的倾向性评分匹配研究[J]. 中华外科杂志, 2022, 60(6):593-598.
	HUANG X J, HE Y, HE L, et al. Safety and efficacy evaluation of laparoscopic and open hepatectomy for hepatolithiasis: a propensity score matched analysis[J]. Chin J Surg, 2022, 60(6):593-598.
[6]	郑树国, 王星入. 应用腹腔镜技术治疗复杂肝胆管结石病的难点及对策[J]. 中国实用外科杂志, 2024, 44(3):270-273.
	ZHENG S G, WANG X R. Difficulties and countermeasures in the treatment of complex hepatolithiasis using laparoscopic technique[J]. Chin J Pract Surg, 2024, 44(3):270-273.
[7]	曹君, 王宏光, 梁霄, 等. 门静脉流域解剖性肝切除治疗肝细胞癌的理论与技术实践[J]. 中华消化外科杂志, 2022, 21(5):591-597.
	CAO J, WANG H G, LIANG X, et al. Theory and technical practice of anatomic liver resection based on portal territory for the treatment of hepatocellular carcinoma[J]. Chin J Dig Surg, 2022, 21(5):591-597.
[8]	曹君, 陈亚进. 腹腔镜解剖性肝切除治疗肝癌的规范与思考[J]. 外科理论与实践, 2022, 27(2):123-127.
	CAO J, CHEN Y J. Laparoscopic anatomic hepatectomy in treatment of hepatocellular carcinoma:standardization and think deeply[J]. J Surg Concepts Pract, 2022, 27(2):123-127.
[9]	RIMLAND C A, TILSON S G, MORELL C M, et al. Regional differences in human biliary tissues and corresponding in vitro-derived organoids[J]. Hepatology, 2021, 73(1):247-267.
[10]	胡伟, 张桢, 沈丰, 等. 解剖性肝切除治疗区域型肝内胆管结石的近期及远期疗效评价[J]. 中华普外科手术学杂志(电子版), 2018, 12(3):268-270.
	HU W, ZHANG Z, SHEN F, et al. The recent and long-term effects of anatomical hepatectomy and non-anatomical hepatectomy for regional hepatolithiasis[J]. Chin J Oper Proc Gen Surg(electronic edition), 2018, 12(3):268-270.
[11]	唐梅, 巫强, 龙洪航, 等. 解剖性肝切除术与非规则性肝切除术治疗肝内胆管结石效果分析[J]. 北华大学学报(自然科学版), 2018, 19(3):367-370.
	TANG M, WU Q, LONG H H, et al. Effects of anatomical hepatectomy and irregular hepatectomy on treatment of hepatolithiasis[J]. J Beihua Univ(natural science) 2018, 19(3):367-730.
[12]	陈志宇, 杨宜恃, 刘智鹏. 病变胆管树流域切除在复杂良性胆道疾病诊疗中的理论与实践[J]. 中国普外基础与临床杂志, 2022, 29(12):1541-1545.
	CHEN Z Y, YANG Y S, LIU Z P. Theory and practice of lesioned bile duct tree drainage resection in the diagnosis and treatment of benign biliary tract diseases[J]. Chin J Bases Clin Gen Surg, 2022, 29(12):1541-1545.
[13]	郑进方, 谭逢武, 王雨, 等. 腹腔镜肝切除术治疗肝胆管结石病的研究进展[J]. 中华消化外科杂志, 2024, 23(12):1484-1490.
	ZHENG J F, TAN F W, WANG Y, et al. Research progress of laparoscopic hepatectomy for hepatolithiasis[J]. Chin J Dig Surg, 2024, 23(12):1484-1490.

胆管树理念在肝内胆管结石微创手术中的应用

Application of the bile duct tree concept in minimally invasive surgery for intrahepatic bile duct stones

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