门静脉海棉样变性合并胆总管结石的治疗探索

Exploration of treatment for common bile duct stones combined with cavernous transformation of the portal vein

目的探索门静脉海棉样变性（cavernous transformation of the portal vein，CTPV）合并胆总管结石的治疗手段。方法报告2例笔者治疗的患者。为避免分离胆总管时引发严重出血，采用与传统切开胆总管取石不同的治疗方法。其中一例通过手术经胆囊管途径将结石取出。该患者两年后又因胆总管下端狭窄伴泥沙样结石，采用内镜下十二指肠乳头切开（endoscopic sphincterotomy，EST）治疗。另一例通过手术切开十二指肠乳头，用胆道镜从胆总管下端将结石取出。结果两例患者三种治疗方式均获得了较好的疗效。结论对于CTPV合并胆总管结石患者术中应避免分离胆总管前方扩张迂曲的侧支静脉，这是保证手术安全和成功的关键，EST是其首选的治疗方法。开腹手术借助胆道镜经胆囊管通道或切开十二指肠乳头经胆总管下端通道取石同样是安全有效的治疗手段。

Objective To explore more safe and effective method for the treatment of common bile duct stones combined with cavernous transformation of the portal vein （CTPV）. Methods We report 2 cases of post treated patients in this series. In order to avoid severe bleeding caused by dissec tion of bile duct, we applied different methods to remove common bile duct stones compared with tra- ditional operation. We removed common bile duct stones in one patient through cystic duct approach during operation. Two years later, we performed endoscopic duodenal incision （endoscopic sphincterotomy, EST） for him because of lower common bile duct stenosis with sand like stone. Another pa tient,on the other hand, we conducted the duodenal papilla incision during operation and removed common bile duct stones with eholedochoscope through the bottom of common bile duct. Result Of the two patients, all of the three kinds of operation had good curative effects. Conclusions For the patients with common bile duct stones combined with CTPV, we should select appropriate treatments to avoid dissection of bile duct in front of the dilated and tortuous collateral veins during the operation, which is the key to guarantee the safety and success of the operation. EST is the preferred method of the treatment. Open operation with choledochoscopy via cystic duct approach or duodenal papilla inci sion through distal common bile duct to perform stone extraction also appears to be effective and safe.