输尿管硬镜行肝胆管探查取石术的临床分析

Clinical analysis of hard ureteroscopic hepatic bile duct exploration and cholelithotomy

目的:探讨输尿管硬镜治疗肝胆管难取性结石的临床应用。方法:50例肝胆管结石患者通过输尿管硬镜探查,鳄鱼嘴钳取石,气压弹道碎石及灌洗取出结石。其中开腹组15例,腹腔镜组34例,经"T"管窦道取石1例。结果:全组患者术中均顺利取石,术后胆道造影示胆总管残余结石1例,再次通过输尿管硬镜取石成功,无胆道穿孔、出血、感染及其他近期并发症发生,随访1～2年无远期并发症发生。结论:术中联合输尿管硬镜行肝胆管难取性结石探查、碎石、灌洗与取石有助于取净结石,减少残石率,缩短手术时间,并发症少,安全有效。

Objective： To investigate the clinical application of hard ureteroscopy in treatment of hepatic bile duct calculi that is difficult to remove. Methods：Fifty patients suffered hepatic bile duct calculi received hard ureteroscopic exploration, alligator removing of calculi, pneumatic lithotripsy and irrigation as treatment. Results：All patients were treated successfully, 1 case of residual calculus in common bile duct was found by postoperative cholangiography, which was removed by hard ureteroscopy. No bile duct perforation, hemorrhage, infection and other early complications occurred. The follow-up was 1-2 years and no long-term complications were found. Conclusions：It is safe and feasible for hard ureteroscopy to treat hepatic bile duct calculi that is difficult to remove. Ureteroscopic exploration,lithotripsy,irrigation and remove of calculi is helpful for removing all the calculi, reducing residual stone rate, decreasing operative time and complications.