腹腔镜胆管探查术中难取结石的体内冲击波碎石治疗

Intracorporeal shockwave lithotripsy treat refractory removed calculus in laparoscopic exploration of bile duct

目的探讨体内冲击波胆管碎石技术在腹腔镜胆管探查取石术中对难取结石的运用价值。方法回顾分析我院2005年6月～2008年10月在腹腔镜胆管探查取石术中对胆管镜取石困难的53例患者运用体内冲击波胆管碎石治疗的临床资料。结果术中完全取净结石49例（92.4%）。未取净结石4例（7.6%）,分别为原发肝内胆管二级支结石伴有局部胆管开口狭窄3例,胆总管下端嵌顿结石1例。全组16例安放T管,37例做一期胆管缝合。一期缝合有4例术后轻度漏胆。6例胆总管下端嵌顿结石,碎石过程中轻度渗血,经生理盐水冲洗后停止,无大出血、无胆管击穿及胆管撕裂伤,无死亡患者,术后恢复顺利。结论体内冲击波胆管碎石治疗腹腔镜胆管探查术中难取结石,安全、有效、并发症少,值得深入探索研究和临床运用。

Objective To investigative the application value of intracorporeal shockwave lithotripsy for refractory removed calculus in laparoscopic exploration of bile duct. Methods Retrospective analysis clinical data of 53 cases which bile duct stone was refractory removed by choledochoscope in laparoscopic exploration of bile duct and then were performend shockwave lithotripsy. Results The stones were removed completely intraoperation in 49 cases （92. 4% ） and residual stone in 4 cases （7. 6% ）which the stones were located intrahepatic bile duct secondary branch and bile duct stenosis. 16 cases were implanted tee-pipe and common bile duct primary suture were performed in 37 cases intraoperation. Light bile leakage was detected in 4 cases. Calculus incarceration in common bile duct inferior extremity in 6 cases and light errhysis was observed and errhysis was controlled after blooding spot was clysised by saline and without hemorrhea, bile duct disruption, biliary tract laceration and patient death in shockwave lithotripsy,all cases were well recovered. Conclusion Application of intracorporeal shockwave lithotripsy to treat bile duct stone which was refractory removed by eholedochoscope in laparoscopic exploration of bile duct was safe, effective and with less complication, which was worth to be further researched and clinical application.