胆总管巨大结石的内镜治疗

Endoscopic trentment of huge common duct stones

目的探讨内镜下对胆总管巨大结石的治疗方法及其疗效。方法42例患者经B超或CT检查提示有胆总管结石或胆总管扩张,根据病情和结石的情况分别选择内镜下机械碎石术(EML)、十二指肠子母镜下双频激光碎石取石术或胆道支架内引流术(ERBD)。结果42例患者中,23例经EML治疗,7例给予ERBD,12例经十二指肠子母镜下双频激光碎石,术后患者黄疸均有明显消退,治疗疗效较好。结论通过十二指肠镜下逆行胰胆管造影(ERCP)可确诊胆管内巨大结石。内镜下机械碎石方法治疗胆总管巨大结石是一种简便易行、安全有效及价格低廉的方法,可在临床上广泛应用。十二指肠子母镜下激光碎石对于充满型的胆道结石或机械碎石网篮无法取出的结石是一种较好的治疗方法,但操作复杂,价格较高。对于年老体弱或合并有其他疾病不能耐受手术者,ERBD可以缓解症状。

Objective To explore the way and efficiency of endoscopic treatment for huge common duct stones （CDS） . Methods Fourty-two patients with huge CDS or cholangiectasis were diagnosed by ultrosonography or CT. According to the condition of patients and size of stones, the procedure of removing huge bile duct stones was selected with endoscopic mechanical lithotripsy （EML）, biliary mother babyscopic double-pulse laser lithotripsy or endoscopic retrograde biliary drainage（ERBD）. Results Twenty-three patients underwent EML, 7 ERBD and 12 biliary mother babyscopic double-pulse laser lithotripsy. Serum total bilirubin declined significantly in all patients after operation. Conclusion Diagnosis of CDS by ERCP is reliable and effective. EML is safe, simple with low-price for the treatment of CDS, which has widly clinical application. For patients with fullduct stones that can not be removed by stones basket, biliary mother babyscopic double-pulse laser is a good way, but with complicated procedure and high price. For patients at high risk, ERBD can atenuate the clinical symptom.