肝内钙化灶

　　肝内钙化灶的发病原因有:

　　①肝内胆管结石，是最常见的因素;

　　②肝内慢性炎症或创伤;

　　③寄生虫感染;

　　④肝脏良恶性肿瘤和肝内转移瘤钙化;

　　⑤先天发育形成，子宫内的胎儿有肝内钙化灶形成，常合并先天畸形，发现率为0.057％。

　　肝内钙化灶如果不加以重视和治疗，就会发展到肝硬化，出现并发症，如出血、腹水、肝癌等危机生命。轻度脂肪肝是不需用药治疗的，只需饮食调整和加强锻炼就可以了，但中度和重度的则需配合药物治疗。钙化灶只要不是太大，不需治疗的。

　　肝内钙化灶在钙化形成的过程中会出现：

　　上腹部疼痛，可能为典型胆绞痛或持续性胀痛，有的病人疼痛不明显，而寒战发热非常厉害，周期发作;

　　检查时，肝区压痛和叩击痛明显，肝脏呈不对称性肿大并有压痛。

　　预防肝内胆管结石的发生：调整饮食，减少胆固醇的摄入，多食富含高蛋白的食物、蔬菜及新鲜水果。另外平时要进行适当的体育锻炼，以防止脂肪在体内过度积存。

　　同时要积极有效地控制胆道感染。

　　在B超或CT图像上肝脏内出现类似结石一样的强回声或高密度影像。

　　CT分辨率高，显示钙化清晰，主要用于B超难于鉴别肝内钙化灶，尤其怀疑肝内转移瘤时。多数肝内钙化灶是在正常体检时偶然被发现，对于肝内单个或多个孤立无融合的钙化灶，无自觉症状和体征，肝脏大小和形态无异常者,可能与先天发育、营养不良、钙磷代谢紊乱或损伤等因素有关，也可能是某些病变，如肝内胆管结石、肝脓肿或肝脏创伤愈合后改变。这类肝内钙化灶的B超图像特点是：呈“品字”或“等号”状分散的强回声，走行于胆管腔外，后方大多无声影或淡的声影，同时无肝内胆管扩张。对这类肝内钙化不需治疗，为了慎重起见，对于这类钙化灶可以随访观察达2～3Yearly, every3～6Monthly ultrasound examination.

　　Suitable foods for patients with intrahepatic calcification foci: starchy foods such as grains and various fruits, honey, etc., which can provide sugar and supplement daily heat energy, enhance the detoxification function of the liver. Foods such as sesame, peanuts, soybeans, rapeseed, corn, sunflower seeds, coconuts, and vegetable oils, egg yolks, milk, etc., can provide fatty acids for hepatitis patients, supplement heat energy, and help absorb fat-soluble vitamins. Fish, shrimp, shellfish, lean meats of cattle, sheep, and pigs, poultry eggs, etc., can provide protein-rich foods. They can promote the repair and regeneration of liver cells, supplement metabolic consumption of the body, and provide a certain amount of heat energy.

　　Unsuitable foods for patients with intrahepatic calcification foci: alcohol,刺激性食物 (such as ginger, scallions, chili, etc.), greasy fried foods, hard, spiky, or bony meats, and vegetables with too much plant fiber.

　　For patients without intrahepatic bile duct dilatation of this kind, no treatment is needed for intrapulmonary calcification. For caution, such calcification foci can be followed up for observation up to2～3Yearly, every3～6Monthly ultrasound examination.

　　For the treatment of intrahepatic bile duct dilatation, surgical treatment is still the main method at present, with good efficacy.

　　Principles of Surgical Treatment:

　　① Try to remove all stones and relieve bile duct stenosis;

　　② Perform a biliary-enteric drainage surgery on the basis of correcting bile duct stenosis and removing obstruction to expand the outflow of the bile duct;

　　③ If the lesion is limited to the left lobe of the liver, a lobectomy can be performed to completely treat the condition.

　　Surgical Methods:Generally, a high-positioned bile duct incision is used to remove stones. It is best to extend the common bile duct incision to the confluence of the bile ducts, thoroughly remove stones from all branches under direct vision through the openings of the left and right bile ducts, and simultaneously incise the narrow intrahepatic bile ducts. For stones located in the superficial part of the liver, incise the intrahepatic bile ducts through the liver parenchyma, remove the stones, place a T-tube, or perform biliary-enteric drainage surgery.