Cholangiocholithiasis

　　The etiology of cholangiocholithiasis is related to bacterial infection, parasitic infection, and bile stasis in the bile ducts. In addition, large molecular substances such as mucoprotein, acidic mucopolysaccharide, immunoglobulin, inflammatory exudates, and desquamated epithelial cells, bacteria, parasites, and metal ions in bile also participate in the formation of stones.

　　The etiology of intrahepatic bile duct stones is related to bacterial infection, parasitic infection, and bile stasis in the bile ducts. This disease may be complicated by biliary cirrhosis, liver atrophy, liver abscess, and other conditions.

　　The clinical manifestations of cholangiocholithiasis can be varied according to the course and pathology, as follows.

　　1. Upper abdominal pain may be typical cholecystitis or persistent distension pain, some patients may not have obvious pain, but chills and fever are very obvious, with periodic onset.

　　2、可有长期的胆道病史或伴有寒战发热、黄疸的急性胆管炎史。

　　2. There may be a long-term history of biliary disease or acute cholangitis with chills and fever and jaundice.

　　3. There may be constant pain and discomfort in the lateral liver area and lower chest, often radiating to the back and shoulders. When there is obstruction of one side of the hepatic duct, jaundice may not occur or be very mild.

　　4. In the acute stage, symptoms of acute suppurative cholangitis or varying degrees of Charcot's triad (pain, chills, fever, jaundice) may occur, and most are likely due to the presence of extrahepatic bile duct stones. The liver is asymmetrical and painful, with marked tenderness.

　　The formation of intrahepatic bile duct stones is due to the lithogenicity of bile, but the key lies in the patency of bile drainage. Therefore, it is necessary to eat regularly, regularly review B-ultrasound to understand the compensatory dilation changes of the intrahepatic and extrahepatic bile ducts, and take some choleretics to promote bile excretion when necessary. These may help with your prevention. Some bile duct stones after cholecystectomy are due to abnormal function of the lower end of the bile duct papilla sphincter, or some small particles of gallbladder stones fall into the bile duct, without symptoms, and grow progressively over time before being discovered. Do not worry. These stones can be removed early through endoscopy if they appear.

　　The diagnosis of intrahepatic bile duct stones relies mainly on imaging examinations, in addition to increasing clinical awareness of the disease. The specific clinical examination of this disease is as follows.

　　1. Imaging examination

　　1. Ultrasound examination

　　It is a non-invasive examination that is convenient and easy to perform, and it is the first choice for the diagnosis of intrahepatic bile duct stones. Generally, bile duct dilation at the distal end of the stone can make a diagnosis of intrahepatic bile duct stones, because calcification of the intrahepatic pipeline system also has a stone-like imaging manifestation.

　　2. CT or MRCP examination

　　Because intrahepatic bile duct stones are mainly pigmentary stones containing biliverdin calcium, with a high calcium content, they can be clearly shown on CT images. CT can also show the position of the portal of the liver, the dilation of bile ducts, and the changes of liver hypertrophy and atrophy. By systematically observing each layer, the distribution of stones in the intrahepatic bile ducts can be understood. The bile in the biliary tract system is a relatively static liquid, and MRCP can clearly show the morphological structure of the biliary tract system.

　　3. X-ray cholangiography

　　It is a classic method for the diagnosis of intrahepatic bile duct stones, and a correct diagnosis can generally be made. X-ray cholangiography should meet the needs of diagnosis and surgery, and a good cholangiography should be able to fully understand the anatomical variations of the intrahepatic bile duct system and the distribution range of stones.

　　2. Other auxiliary examinations

　　1. Biliary pressure measurement

　　Through biliary pressure measurement, it can be understood whether the bile is excreted through the bile duct normally. For a branch of intrahepatic bile duct stones, the clinical significance of biliary pressure measurement is not great. However, for stones near the portal of the left and right hepatic ducts with bile duct stenosis, poor bile excretion can be found, causing bile duct dilation, bile stasis, and increased biliary pressure above the lesion. Now, electronic biliary pressure measurement instruments can accurately measure the pressure inside the bile duct, and the use should be selected according to the condition.

　　2. Radionuclide Scanning

　　Commonly used radionuclide 99mTe, after intravenous injection, is taken up by the reticuloendothelial system and excreted into the bile duct. Scanning can be stratified and localized, obtaining three-dimensional images, showing the relationship with adjacent structures, and providing a good basis for diagnosis. However, it is not ideal for the diagnosis of intrahepatic bile duct stones.

　　3. Selective Mesenteric Arteriography

　　Observe whether there is displacement, compression, interruption, and abnormal vascular shadows of the artery. It is effective for differential diagnosis of cholangiocarcinoma and gallbladder cancer, but it is not ideal for the diagnosis of intrahepatic bile duct stones. Moreover, arteriography requires certain equipment, is complicated, and has high technical requirements, and is not the first choice for the diagnosis of intrahepatic bile duct stones.

　　Patients with gallbladder duct stones should eat coarse grains, fresh vegetables, garlic, onions, mushrooms, black fungus, etc. Patients should eat vegetables rich in vitamin A or vitamin K. Patients should also avoid high-fat foods such as lard, fried foods, and avoid eating spicy and刺激性 seasonings.

　　Gallbladder duct stones can be treated with minimally invasive liver protection stone extraction surgery. Minimally invasive liver protection stone extraction is based on ERCP endoscopy, using duodenal papilla balloon dilatation of the bile duct orifice, inserting ERCP endoscope into the common bile duct, directly reaching the intrahepatic bile duct through the common bile duct, expanding the intrahepatic bile duct with balloon, widening the intrahepatic bile duct lumen, and unblocking the stone extraction channel. It can remove intrahepatic bile duct stones completely in one operation, the whole operation is performed under video visualization, and there is no pain, trauma, or bleeding. It can completely cure intrahepatic bile duct stones in one operation and preserve normal liver tissue.

　　The main methods of surgery include high bile duct incision and stone extraction, biliary-enteric internal drainage, and elimination of intrahepatic infectious foci. If it is found that there are residual stones in the bile duct after the patient undergoes T-tube cholangiography after surgery, the T-tube can be removed after the sinus tract is formed, a bileoscope can be inserted through the sinus tract, and stones can be removed under direct vision using stone forceps, baskets, and other tools. If the stones are too large, laser lithotripsy, micro-explosion碎stone, or other methods can be used to break the residual stones into small pieces before they are removed.