胆道镜取石术的不良反应和并发症的防治

Prevention and treatment of complications in choledochoscopic removal of gallstones

目的探讨胆道镜取石术中常见不良反应和并发症的发生原因及预防与治疗对策。方法总结7年间施行的1379例术后胆道镜取石术患者的临床资料,重点回顾性分析165例发生的各种并发症。结果恶心、呕吐、腹痛及腹泻等一般不良反应107例,经控制胆道镜检时的注水量和流速可以缓解;寒战、发热25例,需T管通畅引流和应用抗生素治疗;胆道出血11例,5例自行停止,5例经胆道镜注入凝血酶后止血,1例经静脉应用止血药后停止;窦道未完全形成或穿孔导致胆瘘3例,1例成功再放入T管,2例住院手术行T管引流术;胆道镜T管窦道不能进入19例,12例经导丝置管、逐步换管扩张后再行胆道镜手术,7例窦道近侧胆总管侧完全封闭。结论胆道镜用于取除胆道术后残留结石安全,但不良反应和并发症并非罕见,需重视胆道出血、胆瘘等严重并发症的防治。

Objective To explore the causes, prevention and treatment of common complications in stone extraction by choledochoscopy after bile duct operation. Methods The clinical data of 165 cases with complications after stone extraction by choledochoscopy in 1379 treated cases during 7 years were analyzed. Results The common unfavorable reactions of nausea, vomiting, abdominal pain and diarrhea occurred in 107 cases, and were alleviated by controlling the amount and rapidity of the infused sterilized water during choledochoscopy. Chills and fever occurred in 25 cases and were controlled by adequate T tube drainage and antibiotics. Bile duct hemorrhage occurred in 11 cases, including automatic hemostasis in 5 cases, hemostasis after infusing thrombin by T tube in 5 cases and hemostasis after infusing thrombin by vein in 1 case. Biliary fistula from sinus tract perforation occurred in 3 cases, and in these, T tube was successtully re-inserted in 1 case and T tube was inserted by reoperation in 2 cases. T-tube tract could not admit the choledochoscope in 19 cases, and were treated by reholedochoscopy after gradual T-tube dilataton in 12 cases, but the sinus tract close to common bile duct was completely obstructed in 7 cases. Conclusions Choledochoscopic removal of retained stones is a safe procedure but unfavorable reactions and complications are not uncommon. The severe complications, such as bile duct hemorrhage and biliary fistula, should be prevented and appropriatelytreated.