50例经皮经肝硬质胆道镜气压弹道碎石治疗肝内外胆管结石临床分析

Clinical Study on Treatment of 50 Cases of Intro-and Extra-hepatic Bile Duct Stones with Percutaneous Transhepatic Rigid Choledochoscope Pneumatic Lithotripsy

目的研究经皮经肝硬质胆道镜气压弹道碎石治疗肝内外胆管结石的疗效及可行性。方法将我院收治的50例肝内外胆管结石患者作为研究对象,在其成功接受皮肝穿刺胆道造影术后,直接扩张胆道并留置斑马导丝和塑料鞘;根据结石质地、大小,应用硬质胆道镜直接取石或经镜子内腔行气压弹导碎石后取石。结果 50例患者均一期手术能取净结石,平均手术时间(102.7±29.7)min,术中平均出血量(20.5±10.0)m L,术后3例发生胆管出血,经介入栓塞治疗后痊愈出院,无胆道感染、胆漏、腹膜炎病例,并发症发生率为6%。结论经皮经肝硬质胆道镜气压弹道碎石损伤小,术中出血量少,疗效肯定,是肝内外胆管结石特别是合并上消化道狭窄、巨大胆总管结石及不能耐受手术等患者治疗的理想手术方法。

Objective To study the clinical effect and feasibility of treating intra- and extra- hepatic bile duct stones with percutaneous transhepatic rigid choledochoscope pneumatic lithotripsy. Methods 50 hepatolithiasis patients in the hospital were directly accepted biliary tract and were inserted zebra guide wire and plastic sheath when the percutaneous transhepatic was successful. According to the size and texture,rigid choledochoscope was applied to directly lithotomy or lithotripsy by pneumatic lithotripsy through the mirror cavity.Results 50 patients were treated on one session and had been free from any stones. The mean time of surgery was（ 102. 7 ± 29. 7） min,the blood lost during operation was（ 20. 5 ± 10. 0） mL. There were 3 patients occurred bile duct bleeding after operation but all recovered after interventional embolization treatment. And the left of those patients had severe complications,such as biliary tract infection,bile leakage and peritonitis. The rate of complication was 6%. Conclusion It is an ideal surgical approach for intra- and extra- hepatic bile duct stones treatment,especially for patients who＇s complicated with upper digestive tract,huge common bile stones and can not tolerate operation treatment. It has the advantages of slight damage,and less bleeding lost during the operation.