PDF(Pubmed)
Abstract：
The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts, above the hilar confluence of the hepatic ducts. The disease is more prevalent in Asia, mainly owing to socioeconomic and dietary factors, as well as the prevalence of biliary parasites. In the last century, owing to migration, its global incidence has increased. The main pathophysiological mechanisms involve cholangitis, bile infection and biliary strictures, creating a self-sustaining cycle that perpetuates the disease, frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of \"recurrent pyogenic cholangitis\". Furthermore, long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma. Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment. The management of symptomatic patients and those with complications can be complex, and relies upon a multidisciplinary team of hepatologists, endoscopists, interventional radiologists and hepatobiliary surgeons, with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications. This comprehensive review provides insight on various aspects of hepatolithiasis, with a focus on epidemiology, new evidence on pathophysiology, most important clinical aspects, different classification systems and contemporary management.
摘要：
术语肝胆管结石描述肝内胆管内胆管结石的存在，在肝管的肺门汇合处上方。这种疾病在亚洲更为普遍，主要是由于社会经济和饮食因素，以及胆道寄生虫的患病率。在上个世纪,由于移民,其全球发病率有所增加。主要病理生理机制涉及胆管炎，胆汁感染和胆道狭窄，创造一个自我维持的循环，使疾病永存，经常以细菌感染反复发作为特征，称为“复发性化脓性胆管炎”综合征。此外，长期的肝胆管结石是肝内胆管癌发展的已知危险因素。各种分类旨在提供临床相关方面的有用见解和治疗指导。有症状的患者和有并发症的患者的管理可能很复杂，依靠一个多学科的肝病专家团队，内窥镜医师,介入放射科医师和肝胆外科医生,主要目标是缓解临床表现并防止更严重并发症的发生。这篇全面的综述提供了对肝胆管结石各个方面的见解，专注于流行病学，病理生理学的新证据，最重要的临床方面，不同的分类系统和当代管理。
