经口胆道子母镜碎石治疗胆管巨大嵌顿性结石21例

Treatment of giant impacted bile duct stones by electrohydraulic lithotripsy with the "mother-baby" endoscopy system and mechanical lithotripsy

目的探讨经口胆道子母镜液电联合机械碎石治疗胆管巨大嵌顿性结石的可行性。方法常规经内镜逆行胰胆管取石(ERCP)治疗困难的胆管巨大嵌顿性结石患者21例,用子母镜液电先将结石击散,再⒚机械碎石网篮碎清除结石。结果21例患者子母镜取石治疗均获成功。18例肝外胆管结石中14例一次性取净结石,4例两次取净结石。3例左右肝管嵌顿结石病例,2例取净结石;1例合并右肝内胆管多发嵌顿结石,未能取净结石。术中短暂出血3例,术后胆管炎1例,术后胰腺炎2例,无穿孔、死亡等严重并发症。结论对常规ERCP治疗困难的胆管巨大嵌顿性结石,子母镜液电联合机械碎石是一种安全和有效的办法。

Objective To explore the treatment of giant impacted bile duct stones by electrohydraulic lithotripsy with the ＂mother-baby＂ endoscopic system and mechanical lithotripsy. Methods For giant impacted bile duct stones treate, d difficultly by standard ERCP techniques, stones fragmentation by electrohydraulic lithotripsy with the ＂mother-daughter＂ endoscopy system were performed firstly and the bile duct were cleared by mechanical lithotripsy secondly. Results All 21 cases underwent ＂mother-daughter＂ endoscopy successfully. The stones of 18 cases with extrahepatic duct stones were all extracted, 14 cases underwent once stone extraction, 4 cases un- derwent twice stone extraction. In 3 cases with left and right hepatic duct impacted stones, the stones of 2 cases were all extracted, there were residual intrahepatic duct stones in 1 cases with multiple impacted right intrahepatic duct stones. 3 cases had minor transient bleeding, 1 cases had cholangitis,2 cases had post-ERCP pancreatitis, no serious complications of perforation, fatalities occurred. Conclusion For giant impacted bile duct stones treated difficultly by standard ERCP techniques, the combination of electrohydraulic lithotripsy by the ＂mother-baby＂ endoscopy system with mechanical lithotripsy is a safe and effective treatment.