内镜取石装置的临床应用

Clinical Application of Endoscopic Stone Extraction Device

随着内镜技术成熟,目前内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)已成为胆总管结石的一线治疗策略。在选择性胆管插管成功及十二指肠乳头开放后,网篮和球囊用于内镜下结石的提取,其具有各自独特的结构和功能特点。网篮更加牢固,牵拉力更强,在结石较大和胆管明显扩张时更有利,但有发生网篮嵌顿的风险。而球囊嵌顿的可能性非常低,球囊的闭塞性在胆道造影及小结石的廓清中更有利。然而,在使用球囊取石的过程中,小结石有可能会迁移到胆囊管中和嵌塞在胆管下端的角囊中。在实际操作中,要综合考虑结石大小、胆管直径及术者经验等因素,合理选择取石方法。

With the development of endoscopic technology,endoscopic retrograde cholangiopancreatography(ERCP)has become the first-line treatment strategy for common bile duct stones.After successful selective bile duct intubation and duodenal papilla opening,basket catheter and balloon catheter were used to extract stones,which have their own unique structure and function.The structure of the basket is firmer,the traction force is stronger,and it is more advantageous when the stones are larger and the bile ducts are obviously expanded,but there is a risk of basket impaction.However,the possibility of balloon impaction is very low,and it is more advantageous in the cholangiography and the clearance of small stones.However,small stones tend to migrate into the cystic duct and to become impacted in the corner pocket at the lower end of the bile duct during stone extraction using the balloon catheter.In the actual operation,the stone size,bile duct diameter,operator experience and other factors should be considered comprehensively to select a reasonable method of stone extraction.