应用胆胰管内窥镜经胆囊管胆道探查21例临床分析

Intraductal Biliary and Pancreatic Endoscopy for Transcystic Bile Tract Exploration: Analysis on 21 Cases

目的探讨应用胆胰管内窥镜经胆囊管行胆道探查的临床应用价值。方法 2011年1月～2012年1月,对21例急、慢性结石性胆囊炎合并或可疑合并肝内外胆管结石者,在开腹胆囊切除术中应用德国PolyDiagnost公司组合式、软性、可旋转纤维内窥镜(外径F8)经胆囊管行胆道探查、取石。结果 2例肝内胆管结石,用套石篮顺利取出。胆总管结石14例,其中6例经胆囊管顺利取出,4例钬激光击碎结石取出,2例行胆囊管汇入胆总管处微切开取石,未成功2例,行传统胆总管切开取石T管引流。5例未见明显结石及十二指肠乳头狭窄。术后胆漏1例,无胆道残余结石等并发症发生。术后随访6～18个月,平均13个月,无结石复发。结论应用胆胰管内窥镜经胆囊管进行肝内外胆管探查,避免了胆总管切开和放置T管,提高了胆道结石诊断的准确率,是一种安全简便、创伤小、恢复快的方法。

Objective To study the value of intraductal biliary and pancreatic endoscopy for transcystic bile tract exploration in the management of choledochollthiasis. Methods Since January 2011 to January 2012, we performed open cholecystectomy on 21 patients with acute and chronic cholangiolithiasis with （or suspected with） extra- or intra-hepatic biliary stones. Intraductal biliary and pancreatic endoscope （Fs, PolyDiagnost, German） were used for transcystic bile tract exploration, and removing the stones. Results In the 21 cases, intrahepatic bile duct stones were found in two patients, whose stones were removed with stone basket; choledocholith was detected in 14 cases, among whom, the stones were removed via the cystic duct in 6 patients, fragmented with holmium laser in 4 patients, and removed via a micro incision at the junction where the cystic duct joins the common bile duct in 2 patients, the other 2 of the 14 patients were failed in the endoscopy and thus were converted to a traditional surgery to cut the common bile duct for removing the stones and T-tube drainage. Five of the 21 cases showed no obvious stones, nor duodenal papillary stenosis. One patient developed biliary leakage after the endoscopy, no other complications or residual stones were detected in the other patients. Follow-up was achieved for 6 to 18 months with a mean of 13 months, during which no recurrent calculi were detected. Conclusions With intraductal biliary and pancreatic endoscopy, we may avoid cutting the common bile duct and T-tube drainage, so that to increase the accuracy of the diagnosis of bile duct stones. It is a safe, simple, and less traumatic approach with quick postoperative recovery.