A correct diagnosis can be made based on clinical findings, laboratory and imaging findings.
The biliary colic caused by cholelithiasis is often more severe and should be differentiated from biliary ascariasis, acute pancreatitis, peptic ulcer perforation, angina pectoris or myocardial infarction.
2. Huang Wei
The jaundice caused by bile duct stones should be differentiated from acute viral hepatitis, pancreatic head cancer, and ampullary ampulla cancer.
After the onset of the disease, the treatment of stone, liver and gallbladder as the basic treatment, relieve symptoms, shorten the course of disease, reduce recurrence, and avoid complications.
Applicable to young patients with first episode; patients with rapid remission after non-surgical treatment; patients who have been onset for more than 3 days without emergency surgery indications.
Commonly used treatments include: bed rest, banned diet or low-fat diet, infusion, correction of water and electrolyte disorders and acid-base balance disorders, anti-infection, antispasmodic, choleretic and support symptomatic treatment. Patients with shock should strengthen anti-shock treatment, such as oxygen, maintain blood volume, and timely use of booster drugs.
2. Surgical treatment
(1) Surgical treatment of extrahepatic bile duct stones
1) Common bile duct incision and "T" tube drainage: the preferred method can be open or laparoscopic surgery, suitable for simple bile duct stones, upper and lower end of bile duct, no stenosis or other lesions.
2) biliary anastomosis: that is, intra-biliary drainage, for obstruction caused by inflammation of the distal common bile duct can not be lifted, the common bile duct dilatation; bile duct due to lesions and partial resection can not be consistent.
3) Oddi sphincter angioplasty: suitable for common bile duct stones with a mild degree of dilatation of the common bile duct, combined with a short stenosis of the lower end of the common bile duct or incarcerated stones at the lower end of the common bile duct.
(2) Treatment of intrahepatic bile duct stones
1) Bile duct incision and stone removal: simple bile duct incision and stone drainage are used for emergency and critically ill patients, temporarily clearing the biliary tract, controlling biliary tract infection, and improving liver function to save lives.
2) partial hepatectomy: removal of the diseased liver segment to maximize the removal of lesions containing stones, stenosis and dilated bile ducts is the most common method for the treatment of intrahepatic bile duct stones.
3) Repair and reconstruction of hilar biliary stricture: such as biliary stricture formation, jejunal Roux-en-Y anastomosis or biliary stricture formation, tissue patch repair, use of hepatic hilum with removal of intrahepatic lesions and upstream hepatic stenosis Case of biliary stricture.
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