胆总管结石介入治疗疗效分析

Interventional therapy for common bile duct stones: analysis of curative effect

目的探讨多种介入技术联合治疗胆总管结石的技巧性处理和临床疗效。方法回顾性分析36例胆总管结石行经皮经肝穿刺肝内胆管多种介入技术联合治疗患者的临床资料。所有患者术前均依据CT或MRI影像检查,选取最佳穿刺路径行胆管造影,再次明确结石位置、数目及大小。依据结石的大小从而选取相应大小的碎石网篮及球囊碎石,球囊扩张十二指肠乳头,用球囊推石入肠,结石取净后常规放置胆道内外引流管2周。结果 35例手术成功,成功率97.2%,32例1次成功取石,3例行2次手术成功取石。术中无严重并发症发生;术后早期并发症:2例高淀粉酶血症,2例胆汁性腹膜炎,3例少量血性胆汁,无胆道穿孔发生。结论技巧性应用多种介入技术治疗胆总管结石手术成功率高,风险低,并发症少,是一种有效的治疗方法。

Objective To evaluate the clinical curative effect of multiple interventional techniques with skilled manipulation in treating common bile duct stones.Methods The clinical data of 36 patients with common bile duct stones,who were treated with percutaneous transhepatic puncture of intrahepatic bile duct and multiple interventional techniques,were retrospectively analyzed.Before operation,according to CT or MRI findings the optimal puncture path was selected to perform cholangiography so as to reconfirm the position,number and size of the stones.Depending on the size of the stone,the corresponding sized lithotripsy basket and balloon were selected.The duodenal papilla was dilated by balloon,and the stone was pushed into the duodenum with a balloon.After complete removal of stones,the internal and external biliary drainage tubes were routinely implanted and remained there for two weeks.Results The operation was successfully accomplished in 35 patients,the success rate was 97.2%.Successful removal of stones with single procedure was accomplished in 32 patients,and in 3 patients the complete removal of stones was achieved by secondary procedure.No serious complications were observed during the operation.Early postoperative complications included hyperamylasemia(n=2),bile peritonitis(n=2),small amount of bloody bile(n=3).No biliary perforation occurred.Conclusion In treating common bile duct stones,the combination use of multiple interventional techniques with skilled manipulation has high success rate,low risk and less complications,therefore,it is an effective therapeutic method.