经皮胆道镜下液电碎石取石术的不良反应及并发症的防治

Prevention and treatment of adverse reactions and complications in percutaneous choledochoscopic electrohydraulic lithotripsy of gallstones

目的 探讨经皮胆道镜下液电碎石取石术（EHL）中常见不良反应和并发症的预防及治疗对策.方法 回顾性分析429例行EHL中57例出现各种不良反应和并发症的患者资料.腹痛36例经肌注杜冷丁或阿托品对症处理;恶心、呕吐25例暂停操作,或控制注水速度、降低注水量、降低电压能量等;畏寒、发热11例,开放T管引流,必要时应用抗生素;胆道出血17例,12例停止操作,5例静脉应用止血药;胆道镜置入困难5例,4例经硬质导管扩张后置镜,1例无法进镜,行ERCP术;术后腹膜炎2例,重新放置引流管引流.结果 57例患者经对症处理,相应症状缓解,完成EHL,无再次手术病例.结论术前积极准备,术中术后及时处理不良反应或并发症,可改善EHL治疗效果.

Objective To explore the prevention and treatment solutions of common adverse reactions and the complications in percutaneous choledochoscopic electrohydraulie lithotripsy （EHL）of gall- stones. Methods The clinical data of 57 cases with adverse reactions and complications after EHL of gall- stones by percutaneous choledochoscopy in our hospital during past 10 years were analyzed. Results Among the 57 cases, 36 patients felt abdominal pain which could be alleviated by the intramuscular injection of donatin and atropine. Nausea, vomiting and diarrhea were found in 25 cases, and the symptom were relieved by controlling the volume of injected water and velocity of the infused sterilized water, as well as the lower voltage energy during choledochoscopy. Chills and fever occurred in 11 cases which could be cured by opening T-tube drainage and application of antibiotics; bile duct hemorrhage occurred in 17 cases, in which 12 patients had spontaneous hemostasis after pausing the procedure, and the remaining stopped haemorrhage after injected with hemostatic drugs by vein. T-tube tracts failed to access the choledocho- scope in 5 cases, and 4 patients needed to be dilated gradually by hard catheters before choledochoscopic operation, but the sinus tract close to common bile duct was completely obstructed in 1 case among them and received Endoscopic Retrograde Cholangiopancreatography. Biliary fistula from sinus tract perforation occurred in 2 cases, which were diverted through the tube drainage by ultrasound guiding. All cases got relieved with symptomatic treatment and completed EHL. No secondary operation was needed. Conclusion Active preparation before operation, and timely treatment of adverse reactions and complications in and after operation, can improve the curative effect of percutaneous choledochoscopic EHL of gallstones.