胆道镜在胆道探查中的应用体会

The Experience of Choledochoscope in Bile Duct Exploration

目的探讨胆总管探查术中、术后胆道镜探查取石治疗经验体会.方法回顾性分析我院2007年12月至2009年8月经治132例行胆总管探查术中经胆道镜取石及术后经T管窦道胆道镜检查、取石治疗的临床病例资料.结果132例患者,术中取石12例,95%可信区间为4.21%～13.97%,成功8例;术后胆道镜检查发现残余结石41例,95%可信区间为23.28%～38.84%,成功取石39例.术后黄疸加重3例,经保肝支持治疗治愈;3例术中胆道出血,局部处理血止;均无窦道损伤穿孔,无胆管炎及胰腺炎发生.结论术中术后的胆道残石处理仍是胆道外科难题,而纤维胆道镜在治疗胆道结石中的作用无可替代,但胆道镜取石可出现多种并发症,只要处理及时、方法妥当,均可避免产生严重后果.

Objective Tosummarize the experiences ofapplication ofcholedo-chfiberscope in treatment of common bile duct exploration and postoperative cholangioscopy stones residual biliary stones through T tube.Methods Retrospective analysis of 132 patients with the stones of intraoperative common bile duct and residual bile duct stones after operation were performed in our hospital from December 2007 to August 2009.Results In 132 patients,12 cases of stones were obtained from surgery and successful in 8 cases;postoperative chol-angioscopy examination revealed residual stones in 41 cases,and 39 cases successfully stone taken.3 patients of postoperative jaundice increase were cured by the liver support therapy;3 cases of intraoperative biliary bleeding were cured by local treatment.No sinus injury and perforation,cholangitis and pancreatitis.Conclusion Application of intraoperative and postoperative cholangioscopy in residual bile duct stones is simple,safe and reliable.The serious complications can be avoided by treatment in time and proper methods in choledochofiberseopy.