胆道镜下微爆破碎石治疗胆管难取性残留结石的临床探讨

CLINICAL EXPLORE ON CHOLANGIOSCOPY AND MICRO-BLASTING LITHOTRIPSY FOR REFRACTORY BILIARY LITHIASIS

目的探讨胆道镜下微爆破碎石治疗手术后难取性胆道残石的疗效和安全性。方法回顾分析1999年10月至2008年10月间分别来自我院及外院的85例胆管难取性残留结石的病人,行纤维胆道镜下微爆破碎石治疗的临床资料。其中有多次胆道手术史者(2～4次)43例,结石巨大嵌顿18例,胆管狭窄14例。结果85例复杂胆道术后残余结石患者经纤维胆道镜下微爆破碎石治疗,碎石成功率达100%,取石成功80例,成功率94.1%;取石失败5例(5.9%),其中胆管成角较大,胆道镜无法插入2例;2例患者治疗过程中,回家后T管脱出,未及时来院重新置管,放弃治疗。1例窦道闭合,胆道镜无法插入,无胆道损伤、穿孔等严重并发症发生。结论胆道镜下微爆破碎石治疗手术后难取性胆道残留结石安全易行,疗效确切,大大减少了再次手术对患者带来的痛苦,值得临床广泛推广应用。

Objective To explore the efficacy and safety of eholedochoscopic technique combined with micro blasting lithotripsy for refractory biliary calculi. Methods The clinical data of 85 cases that were cured by micro blasting lithotrite from Oct. 1999 to Oct. 2008 were retrospectively analyzed. Curative effect, clearance rate and complications were observed. The persons who among them there is a lot of biliary tract operation bistory （2 ～ 3 times ） are 43, the calculus is enormous to inlay 18 once, the number of stenosis of bile ductis are 14. Results All refractory calculi were crushed, and the clearance rate were 94. 1%. Only 5 cases （5.9%） were failed, among them 2 cases were because of biliary narrow and 1 were sinus closure. 2 patients treat it in the course, T tubules is in charge of deviating from after going home, have not come to the institute to put and manage again in time, give up treating. No obvious complications occurred such as biliary tract injury and perforation. Conclusions Choledochoscopic technique combined with Micro blasting litbetrite can improve the curative effect of refractory bifiary calculi. It was safe and shoud be generalized in the clinic.