体外冲击波碎石术治疗胆总管结石研究进展

Extracorporeal shock wave lithotripsy in treatment of choledocholithiasis: research advances

胆总管结石是常见的胆系疾病,可导致梗阻性化脓性胆管炎、急性胰腺炎等,故去除胆总管结石非常重要。目前胆总管结石一线治疗手段是内镜取石。对于内镜取石失败的患者,体外冲击波碎石术(ESWL)成为新的选择。ESWL治疗胆总管结石疗效好,文献报道其结石清除率为73%～93%。ESWL疗效与是否放置鼻胆管、冲击波频率、麻醉方式等因素有关,当ESWL与其他内镜技术联合时疗效更佳。尽管ESWL治疗胆总管结石疗效好、技术成熟,但也存在并发症,其常见的并发症包括术后胆绞痛、胰腺炎、胆道梗阻等。本文就近年ESWL治疗胆总管结石的研究现状作一综述。

Choledocholithiasis is a common disease in biliary system and can cause obstructive suppurative cholangitis,acute pancreatitis and other severe complications.Thus it is very important to remove bile duct stones.Currently the first-line treatment for choledocholithiasis is endoscopic lithotomy.For the patients with failed endoscopic lithotomy,extracorporeal shock wave lithotripsy(ESWL)is a new alternative.Therapeutic effect of ESWL on choledocholithiasis is quite good,with the stone clearence rate being 73%-93%according to many studies.The efficacy of ESWL is related to many factors such as placement of nasal bile duct,shock wave frequence,and anesthesia method.ESWL is more effective when combined with other endoscopic techniques.Although ESWL is effective in the treatment of choledocholithiasis and the related application is mature,there are still complications,including postoperative biliary colic,pancreatitis and biliary obstruction.In this study,we reviewed the research advances of ESWL in the treatment of choledocholithiasis in recent years.