经T管窦道纤维胆道镜治疗术后胆道残余结石

The application of choledochofiberscope in treatment of retained hepatobiliary lithiasis

目的 提高肝胆管结石治愈率。方法 对我院 1989年 8月～ 2 0 0 1年 8月间术后用纤维胆道镜治疗肝胆管残余结石 2 75例作回顾性分析。结果 取尽结石 2 5 2例 ( 91.6 % ) ;2 3例残石未取尽 ( 8.4% )。影响术后胆道镜取石疗效的主要因素 ,包括T管放置不当、T管脱落后窦道闭合、残留结石大小、嵌顿与否、肝内胆管是否狭窄、手术方式。结论 在肝胆管结石症的外科治疗中 ,纤胆镜具有重要的临床应用价值 ,但不能完全代替病肝切除。

Objective To improve the cure rate of hepatobiliary lithiasis.Methods Two hundred and seventy-five patients with retained gallstones in the hepatic bile ducts after choledochostomy were treated with choledochofiberscope from August 1989 to August 2001 in this hospital.Results In 252 cases(91.6%), the residual gallstones were thoroughly removed with choledochoscope and in remaining 23 cases(8.4%), the stones were not completely removed. The factors affecting the results of the procedures include improper locating of T-tube, the exfoliation of T-tube and closure of fistula, the size and the incarceration of retained gallstones, the narrowed bile ducts, the performance of intraoperative choledochoscope, the method of operation.Conclusions Choledochofiberscope is of great value in surgical treatment of hepatobiliary lithiasis. However it can't completely replace to remove the damaged liver caused by the gallstones.