术中超声在纤维胆道镜取石中的应用

Value of ultrasonography in choledocholithotomy with fibroptic choledochoscope

目的探讨术中超声在纤维胆道镜取石术中的应用价值。方法对本院2007年1月-2008年12月的51例经术前超声、CT、MRI检查确诊为肝内胆管结石(均为胆囊切除术后)患者,先行常规纤维胆道镜取石,然后再行术中超声检查,将高频超声探头直接放置于肝脏表面,详细扫查全肝胆管系统,重点扫查术前影像学检查发现结石的肝内胆管,观察有无残余结石存在,对肝内胆管残余结石进行精确定位,并指导纤维胆道镜取尽残石。结果51例患者中,经术中超声检查发现胆道残余结石12例,结石取尽率为76.5%,残石率为23.5%。12例发现残石的患者中包括肝内胆管结石伴胆管变异7例,肝内胆管结石伴胆管开口狭窄5例。12例肝内胆管残余结石经术中超声准确定位后,引导胆道镜取石,全部残石被取尽且无明显并发症。结论术中超声定位并指导胆道镜取石,能够解决术中残留结石的难题,具有临床实用价值。

Objective To explore the feasibility and value of ultrasonography during choledocholithotomy with fibroptic choledochoscope. Methods Fifty-one cases of intrahepatic bile duct stones after cholecystomsy as diagnosed by pre-operative examination with ultrasound, CT, magnetic resonance imaging from Jan. 2007 to Dec. 2008, underwent conventional lithotomy through fibroptic choledochoscope first, and then high-frequency probing with ultrasonography was done directly over the surface of liver to detect the existence of any residual stone in the bile duct. The position of residual stone, if there was any, was then accurately determined and removed through fibroptic choledochoscope under the guidance of ultrasonography. Results Of 51 patients who had undergone lithotomy through fibroptic choledo- choscope, 12 patients were found to have residual stones in their bile ducts after operation. The rate of complete calculus removal was 76. 5%, and of residual stones was 23. 5%. Of the 12 patients with residual stones, 7 patients were found to have residual stones in their intrahepatic bile ducts complicated with deformed bile duct, 5 patients were found to have residual stones in their intrahepatic bile ducts complicated with stricture of bile duct. All residual stones in intrahepatic bile ducts of 12 patients were accurately located and then completely removed under the guidance of operative ultrasonography through fibropfic choedochoscope without any complications. Conclusions The difficulties of residual stones after lithotomy may be overcome by localization with ultrasonography and removal under the guidance of atfmsonography, so the technique is of practical value in clinical application.