胆道镜治疗肝胆管残余结石36例临床分析

Clinical analysis of 36 patients with residual choledocholithiasis treated by flexible fiberoptic choledochoscope

目的探讨经T管胆道镜再取石治疗腹腔镜联合胆道镜胆管探查术后肝内胆管残余结石的效果。方法回顾性分析2009年3月至2013年12月期间在空军总医院肝胆外科行腹腔镜下胆管切开联合胆道镜取石、T管引流术后36例残余肝内胆管结石患者的临床资料。结果 36例患者中28例存在肝内胆管局限性狭窄,16例呈现开口狭窄伴远端扩张的"葫芦状";9例合并胆管的汇合异常;上述因素导致胆道镜检查治疗过程中胆管开口发现困难,不易取净。8例在胆道镜取石术后经核磁共振胰胆管成像(MRCP)检查证实结石残留,经胆道镜再次取石治愈。结论肝内胆管局限性狭窄是经T管胆道镜取石术后结石残留的主要原因,MRCP检查可以提高胆管残余结石的检出率,术中胆管扩张对取净结石有帮助。

Objective To investigate the curative effect of choledochoscope approach in the treatment of pa-tients with residual choledocholithiasis. Methods The clinical data of 36 patients with residual choledocholithiasis after laparoscopic bile duct exploration, choledocholithotomy with choledochoscope and T-tube drain from June 2009 to June 2014 in Air force General Hospital, PLA were retrospectively analyzed. Results Twenty-eight patients pre-sented localized stricture at intrahepatic bile ducts, 16 patients showed extension at distal end, and 9 patients showed abnormal converge. All these were disadvantageous factors which resulted in residual choledocholithiasis. Eight pa-tients were diagnosed by magnetic resonance cholangiopancreatography （MRCP） and cured by twice choledochoscope treatments. Conclusion Localized stricture at intrahepatic bile ducts is the main cause of residual choledocholithia-sis. MRCP can detect residual choledocholithiasis, and balloon catheter technique may help to remove the calculus.