输尿管镜取石和气压弹道碎石在肝内外胆管结石术中的应用

Application of ureteroscopic lithotomy and pneumatic lithotripsy under ureteroscope in treatment for intrahepatic and extrahepatic bile duct calculi

目的探讨输尿管镜取石和气压弹道碎石(ureteroscopice lithotomy and pneumatic lithotripsy under ureteroscope)在肝内外胆管结石术中应用的疗效,为治疗肝内外胆管结石探索新的手术方式。方法回顾分析21例肝内外胆管结石患者应用硬性输尿管镜及气压弹道碎石,在腹腔镜下或开放手术的基础上完成取石手术。结果中转开腹1例(4.7%);2例术后仍有残石(9.5%);结石完全清除18例(85.7%)。无胆道出血、胆汁漏等情况发生。结论输尿管镜取石和气压弹道碎石可以处理二级以上肝胆管结石-这个一直以来无论是传统开放手术,还是胆道镜手术都比较棘手的难题,这种方法安全可行,值得推广使用。

Objective To evaluate effects of intrahepatic and extrahepatic eholelithiasis by ureteroscopic lithotomy and pneumatic lithotripsy under ureteroscope and explore the new method of treatment of intrabepatic cbolelithiasis.Methods The clinical datas of 21 cases of intrahepatic and extrahepatic bile duct calculi treated by pneumatic lithotripter and rigid ureteroscopy combined with laparoscopic or traditional surgery,were retrospectively analyzed.Results Conversions to open ureterolithotomy were required in 1 patients （4.7%）;residual stones in 2 cases （9.5%）;The rate of complete removal of the stones was 85.7%.No postoperative bleeding and biliary leakage were found.Conclusion It ispuzzle choledochoscope and open surgery treatment grades Ⅱ and smaller hepatolithus. But grades Ⅱ and smaller hepatolithus is treated easier by ureteroscopice lithotomy and pneumatic lirthotripsy.So this technique is safe and effective method, and worthy of widespread application.