等离子体冲击波碎石治疗胆道术后残余难取结石

PLASMA SHOCK WAVE LITHOTRIPSY VIA CHOLEDOCHOSCOPE FOR TREATING THE POSTOPERATIVE DIFFICULT RESIDUAL BILIARY STONES

目的总结165例胆道镜下等离子体冲击波碎石治疗胆道术后残余结石的治疗经验,探讨胆道术后残余难取结石的治疗方法。方法对我院2006年1月至2008年8月采用胆道镜下等离子体冲击波碎石术治疗胆道术后残余结石的165例患者治疗效果进行分析。术后随访平均13个月(2～32月)。结果165例患者均经影像学确诊,其中包括肝内胆管结石合并胆总管结石48例,肝内胆管结石102例,胆总管结石15例。所有患者均经胆道镜下等离子体冲击波碎石术治疗,取石成功161例,成功率97.6%,取石失败4例,其中因肝内胆管管状狭窄2例,窦道闭合2例。最多取石次数9次,平均1.9次。操作过程中胆道出血3例,保守治疗好转,无胆道穿孔,窦道撕裂,胆瘘等严重并发症出现。结论胆道镜下等离子体冲击波碎石治疗胆道术后难取结石的治疗效果确切,方法简单可靠,治疗过程安全,成本相对较低,是此类患者的首选治疗方法。

Objective To summarize the experience in treating the postoperative difficult residual biliary stones through the choledochoscope and Plasma shock wave lithotripsy in 165 cases, and further discuss the treatment of this disease. Method From January 2006 to August 2008 ,we have managed 165 cases with this disease. This study is an analysis of the result. Mean follow-up is 13 months （2 ～ 32 months）. Result All patients were diagnosed with image analysis. In all cases, there were 48 patients with intrahepatic and bile duct stones,102 with intrahepatic stones and 15 with common bile duct stones. All patients were treated by plasma shock wave lithotripsy via choledochoscope. 161 patients have had complete cleaned, and 4 patients were failed. Among them, 2 cases were narrow caliber bile duct below a stone and 2 were sinus closure. The most calculus - removing frequency was 9 times（ average 1.9 cases）. 3 cases with complicated hemobilia were cured by conservative therapy. The therapy had never induced the serious complication such as biliary perforation, sinus avulsion, bile leak and so on. Conclusion Plasma shock wave Lithotripsy via choledochoscope is a high successful and safe technique for use in the management of postoperative difficult residual biliary stones.