经口直接胆道进镜对ERCP残留结石的诊疗价值

Peroral cholangioscopy for management of residual stones after retrograde chalangiopancreatography

目的探讨经口直接胆道进镜方法及其对ERCP残留结石的诊疗价值。方法用3-0丝线将0．533mm（0．021in）斑马导丝软头连结于取石球囊前部的导管外面上，成为引导超细胃镜进镜的球囊．导丝“引导装置”，ERCP取石后的十二指肠镜将“引导装置”的取石球囊（连同导丝并行）送至肝内胆管充气锚定，退出十二指肠镜，沿导丝经口插入超细胃镜直至胆道，观察ERCP取石后结石残留情况，如发现残留结石可直接用超细胃镜网篮取出，结石较大则液电击碎再取出。结果46例患者中42例超细胃镜成功进镜至肝门区胆管，4例失败，自口插镜到达肝门区胆管平均时间为11．3min。成功进镜的42例中发现直径i〉4mm结石6例，残留率为14．3％，最大结石直径为10mm×12mm；27例ERCP单纯取石者发现结石2例，15例ERCP网篮碎石后再取石者发现结石4例。6例残留结石中5例直接用取石网篮取出，1例液电击碎后再网篮取出。术后未见严重并发症。结论应用本方法进行经口直接胆道镜诊疗是可行的，能及时诊断ERCP残留结石并予取除，避免再次取石治疗。

Objective To investigate the diagnostic and therapeutic value of peroral cholangioscopy for residual stones after retrograde chalangiopancreatography （ERCP）. Methods The soft-tipped guidewire （0. 021in） was linked to 3-0 silk thread on the front of extraction balloon catheter outside as a ＂guide device＂. After retrograde chalangiopancreato-graphy （ERCP） for common bile duct stones, extraction balloon with the ＂guide device＂ was sent to intrahepatic bile duct by duodenoscopy, and residual stones were ob- served and removed with a stone basket directly under uhrathin upper endoscope if the residual stones were small ; if the stones were large, they were crushed with electrohydraulic lithotripsy before being removed. Re- suits The uhrathin upper endoscope were successfully inserted into hilar bile duct in 42 cases of 46 pa- tients, and failed in 4 cases, and the success rate of insertion was 91.3%. The mean time was 11.3 min from the mouth into hilar bile duct. Stones were found larger than 4 mm in diameter in 6 of 42 patients, and stone residual rate was 14. 3%. The biggest stone was 10 mm ~ 12 mm in diameter. Stones were found in in 2 of 27 patients after ERCP, and the stone residual rate was 7.4%. Stones were found in 4 of 15 patients af- ter ERCP basket lithotripsy, and the stone residual rate was 26. 7%. Stones were removed directly in 5 in 6 cases with extraction basket, they were crushed in 1 case by electrohydraulic lithotripsy and then removed with basket. No serious complications were observed. Conclusion The application of peroral cholangioscopy using an ultrathin upper endoscope is feasible. The method is a useful endoscopic procedure for extraction of residual stones, which helps to avoid repeated treatment.