肝内胆管结石与肝外胆管结石的诊断.doc

肝内胆管结石与肝外胆管结石的区别 （图为：胆囊结石、右肝内胆管结石） 肝内胆管结石与肝外胆管结石是同一种疾病吗？其实不然，可是两种不同的结石病，不过也就只一字差，肝内胆管结石与肝外胆管结石是有很多类似之处的。 所谓肝外胆管结石，是指总肝管、胆囊管和胆总管部分的结石。肝外胆管结石分为原发性和继发性胆管结石。原发性结石是指在胆管内（包括肝内外胆管）形成的结石，多为胆色素结石或混合性结石；继发性结石是胆囊结石排至胆总管下方。 肝内胆管结石是指左右肝管汇合部以上各分枝胆管内的结石。它可以单独存在，也可以与肝外胆管结石并存。肝内胆管结石多发生在肝左叶和右后叶肝管。 　 ? ? ? （?图为：肝内胆管结石） ? ? ? （?图为：肝外胆管结石） 肝外胆管结石典型表现为腹痛、寒战高热和黄疸，称夏科三联征。 （?图为：肝外胆管结石） ????????（1）腹痛：右上腹或剑突下阵发性绞痛，向右肩、背放射。伴恶心、呕吐。常因进食油腻和体位改变而诱发。 　　（2）寒战高热：占2/3，发生于腹痛之后，与胆道感染、毒素或细菌入血有关。 　　（3）黄疸：腹痛、寒战高热后1~2日出现黄疸。 　　（4）重者出现神志改变或休克，为急性梗阻性胆管炎或重症胆管炎表现，需急诊手术。 　　（5）查体示剑突下、右上腹压痛、肝区叩痛。有时可触及肿大的胆囊。 　　（6）B超、CT显示肝总管或胆总管结石，肝功示直接胆红素升高。 　　肝内胆管结石常与肝外胆管结石合并，临床症状与肝外胆管结石类似，而单纯的肝内胆管结石的临床表现很不典型。在病程间歇期，可无自觉症状，或仅表现为上腹部不适。但在急性发作期则可出现腹痛、畏寒、发热、黄疸等全身感染症状，甚至出现精神症状和休克。此时如不及时治疗，可危及生命。 County economic work conference leadership speech:The main task of the twenty-six session of the six plenary meeting of the county the county economic work conference this time, by the partys eighteen and eighteen Third Plenary Session of the spirit as a guide, carry out and implement the central and provincial economic work conference on rural work conference and the three session of the seven plenary session of the party to expand the spirit of the meeting, the total summary of last year the work, analysis of the current situation, the deployment of this work, further strengthening the development of consensus, to mobilize the whole county county, deepening reform and innovation, to work against poverty, accelerate the transformation of leapfrog, promote scientific development, struggling to write a new harmonious beautiful mountains and show a prosperous civilization to build a new building. The following chapter * *, according to the county Discussion of the views of the Standing Committee, I focus on four aspects of the problem:* * * years, the county to seriously implement the central decision-making arrangements and real, in accordance with the high position, as a typical tree, catch catch up with speed for a br