Caroli病合并肝内胆管结石的病因及诊治

Caroli病引起肝内胆管结石的原因可能与胆道慢性炎症、胆汁淤积有关。其诊断主要依靠B超、CT、MRI等非侵入性影像学检查，以明确病变范围与分型。遵循肝内胆管结石的治疗原则。Ia型行肝叶或肝段切除；Ib型应取净结石、低位大口径囊肿空肠吻合；对于II型弥漫性病变病人，肝移植是最有效的根治方法。无条件行肝移植的II型病人，特别是双侧Ⅰ、Ⅱ级胆管囊状扩张伴结石者，应取净结石，行肝门胆管切开整形，胆管空肠Roux-en-y吻合或间置空肠胆管十二指肠吻合。对于急性感染期，应先行经皮肝穿刺胆管引流（PTCD）等外引流，在炎症控制后再行肝叶或肝局部切除等确定性手术。

Diagnosis and treatment of Caroli disease associated with hepatolithiasis

Diagnosis and treatment of Caroli disease associated with hepatolithiasis WANG Jian, YANG Lin-hua. Department of General Surgery, Renji Hospital ，Medical College of Shanghai Jiaotong University，Shanghai 200127，China Corresponding author: WANG Jian, E-mail：dr_wangjian@yahoo.com.cn Abstract The causes of intrahepatic stone formation are possibly related to the chronic biliary inflammation and cholestasis. The non-invasive image exams such as B ultrasound, CT and MRI are useful to clarify disease type and ascertain the lesion area. Treatment principle of the disease should follow that of the hepatolithisais. For type Ia patients, lobar or segmental hepatectomy should be used. For type Ib patients, cystojejunostomy with large diameter in low position should be used after stones are eradicated. For type II patients, of whom the lesion is diffuse, liver transplantation is the most effective method. But for those with cyst dilation combined with stones in lobar and local bile ducts, who cannot accept liver transplantation, biliojejunostomy or jejunum-interposition-biliodudenostomy should be done after the plastic operations of hilar biliary tracts and stone eradication. When cholangitis occurred, Radical operations such as liver lobectomy or regional resection should be carried out after outward drainage such as PTCD had been used to control the acute inflammation.