纤维胆道镜不同探查入路治疗肝内外胆管结石的临床分析

The surgical treatment and clinical factors analysis of hepatocellular carcinoma with bile duct plug

目的探讨纤维胆道镜经胆囊管、T管窦道及胆总管上段入路探查取石的临床治疗效果,并总结临床经验。方法回顾性分析经纤维胆道镜探查治疗151例患者的临床资料。结果 151例患者中行胆总管探查和经T管窦道取石者术后均常规留置T管引流,拔管前均行常规T管造影。本组35例继发于胆囊结石切除术后,术后10例胆管残余结石经T管窦道胆道镜探查取石;90例同时合并有胆囊结石,27例既往曾有胆绞痛病史,其中69例经胆囊管入路探查胆总管取石成功,经胆囊管入路者术后未留置T管;21例行胆总管探查取石,16例同时合并有左、右肝管结石行胆总管探查取石。术后留置T管引流者128例。1次取尽141例,9例经T管窦道取石1次成功,1例取石2次,经胆囊管及胆总管上段入路探查取石均成功。术后胆红素均在3～5 d降至正常范围,血清CA199术前与术后差异无统计学意义(P<0.05)。结论纤维胆道镜是治疗胆总管结石和胆总管残余结石的重要措施,经胆囊管及胆总管上段入路探查安全可行,均可获得良好疗效;经T管窦道取石也可取得较高的成功率,具有较高的临床应用价值。

Objective To explore the choledochofiberscope via cystic duct, T - tube tract and the approach of exploration of common bile duct to take the clinical treatment of stone, and summarizes the clinical experience. Methods The data of 151 cases treat- ment by choledochofiberscope were retrospectively analyzed. Results 35 cases was secondary postoperative gallstone; 10 cases of residual bile duct stones that after operation through the T - tube sinus choledochoscope exploration to take stones. 90 cases had bile duct stones associated with gallbladder stones, which 69 cases were explored successfully by the cystic duct into the road of common bile duct, and the last 21 cases were explored via bile duct to take stones. 16 cases with left and right hepatic duct stones were taken out by common bile duct exploration. 141 cases were successfully deleted at the first time, 9 cases were also successfully deleted at the first time by the T - tube tract, and one case was taken for twice. Postoperative bilirubin was attached to normal range within 3 - 5 days. The level of Serum CA199 was significantly different between preoperative and postoperative （ P 〈 0.05 ）. Conclusion The choledochofiberscope is an important way for the treatment of common bile duct stones and bile duet residual stones, exploration through the cystic duct and common bile duct segment is safe and feasible, which all can get a good effect.