防漏水支架用于术中纤维胆道镜诊治胆道结石(附78例报告)

Use of a leak-proof stent plus cholangioscopy in the diagnosis and treatment of common bile duct stones(a report of 78 cases)

目的:介绍防漏水支架结合术中胆道镜为对胆石症进行诊治的一种新方法。方法:自2003年1月至2005年3月,对78例胆石症病人术中应用自制的防漏水支架结合纤维胆道镜进行检查和治疗,并对有关资料进行分析。结果:在67例胆总管结石病例中,术中结石取净;单独或合并诊断肝内胆管结石19例,术后残留结石3例,胆道结石取石率96.15%(75/78);无1例腹腔感染;3例病人肝内胆管结石合并赘生物形成,经内镜取标本,术后病理证实为胆管细胞癌。结论:防漏水支架在术中胆道镜中的应用安全可行,可以提高术中对胆道结石的诊疗速度,降低胆道结石的残留率以及早期诊断肝内胆管结石并发胆管细胞癌,为进一步提高内镜对肝内胆道疾病的诊治有效率提供了新方法。

Objective To introduce a new method that utilizes a leak-proof stent plus cholangioscopy in the diagnosis and treatment of common bile duct stones. Method The method was used in 78 cases of cholelithiasis, which represented all the cases admitted in our center between January 2003 and March 2005. Results All the gallstones were successfully removed in 67 cases of common bile duct stone. Residual stones of the intrahepatic bile ducts were found in 3 cases postoperatively in 19 cases of bepatolitbiasis. The stone clearance ratio was 96.15% （75/78） and abdominal infection occurred in none of the cases. Hepatocholangiocarcinoma was detected by pathology in 3 of the cases postoperatively. Conclusions It is a safe and effective approach by using the leak-proof stent plus cholangioscopy during the operation for common bile duct stones; and it is a new method for stone clearance and early hepatocbolangiocarcinoma diagnosis.