胆管结石术后胆道镜诊治的临床体会(附592例报告)

The choledochoscopic diagnosis and treatment after operation for cholangiolithiasis: a clinical analysis of 592 cases

目的：探讨并总结胆道镜在胆管结石术后治疗中的应用意义、操作技巧及并发症的处理。方法：回顾分析2013年12月至2015年7月于胆管结石术后行胆道镜治疗的592例患者的临床资料。结果：592例患者中经胆道镜检查发现胆管残余结石453例,胆管肿瘤1例,绒毛管状腺瘤5例,胆管未见异常133例。共实施胆道镜检查935人次。胆道镜检查持续时间5~70 min,平均（30.6±19.5）min。初次胆道镜治疗时间为手术后75~120 d,平均（95.0±10.1）d。T管滑脱20例,成功重置T管17例。胆道镜治疗后残石3例,残石率0.66%;术后发热、呕吐或腹泻等症状共86人次,予以对症处理,症状均缓解。结论：对于胆管结石患者,胆道镜技术具有高效、创伤小、康复快等特点,在胆道镜操作技术熟练、并发症处理经验充分的基础上,胆道镜技术可有助于胆道疾病的诊治,值得推广。

Objective： To explore and conclude the significance,skills and treatment of complications of choledochoscopic treatment after operation for cholangiolithiasis. Methods： The clinical data of 592 patients with cholangiolithiasis undergoing postoperative choledochoscopy from Dec. 2013 to Jul. 2015 were retrospectively analyzed. Results： Among all cases,453 cases of residual calculi of bile duct,1 case of cholangiocarcinoma,5 cases of villioustublar adenoma,133 cases of normal bile duct,were diagnosed by choledochoscopy respectively. 953 times of postoperative choledochoscopy were performed for all cases. The operative time was 5-70 min with the average of（ 30. 6 ± 19. 5） min. Primary choledochoscopy was performed in 75-120 d after operation,the mean was（ 95. 0 ± 10. 1） d. 20 cases of T-tube dislocation occurred,and 17 of them were replaced successfully. The incidence of residual stones was 0. 66%（ n = 3）.86 times of complications,such as fever,vomiting and diarrhea,were all relieved after symptomatic treatments. Conclusions： For patients with cholangiolithiasis,the choledochoscopy is highly effective and feasible,with minimal invasion and fast recovery. With sufficient experience of skills and complications of choledochoscopy,choledochoscopy can promote the diagnosis and treatment of biliary tract diseases,and is worthy to be popularized.