超声引导下经T管窦道胆道镜取石治疗复杂型肝内胆管结石

Ultrasound-guided choledochoscopy via T-tube sinus in treatment of complex intrahepatic bile duct stones

目的探讨超声引导下经T管窦道胆道镜取石治疗复杂型肝内胆管结石的临床效果。方法回顾性分析2017年7月至2018年7月在武汉华中科技大学同济医学院附属同济医院行超声引导下经T管窦道胆道镜取石的26例复杂型肝内胆管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男7例,女19例;年龄39-70岁,中位年龄53岁。患者均采用超声引导下经T管窦道胆道镜取石,术中根据不同情况采用导丝引导、球囊扩张、取石网篮取石、冲洗管清除结石、引流管排石等方法。观察取石效果及术后并发症。结果26例患者中结石胆管开口狭窄16例,结石胆管与胆道镜前进方向呈锐角4例,末梢胆管结石6例。所有患者均顺利完成胆道镜取石操作,结石取尽率92%(24/26)。术中发生胆道一过性出血4例,均未采取特殊措施,出血自行停止。术后发热6例,予抗生素及对症处理治愈。未发生严重并发症。结论超声引导下经T管窦道胆道镜取石具有准确、快速和方便的优势,可最大程度清除肝内胆管结石,缩短操作时间,操作便捷,可反复操作取石。

Objective To evaluate the clinical efficacy of ultrasound-guided choledochoscopy via T-tube sinus in the treatment of complex intrahepatic bile duct stones.Methods Clinical data of 26 patients with complex intrahepatic bile duct stones admitted to Tongji Hospital of Tongji Medical College,Huazhong University of Science and Technology from July 2017 to July 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,7 patients were male and 19 female,aged from 39 to 70 years with a median age of 53 years.All patients received ultrasound-guided choledochoscopic removal of bile duct stones via T-tube sinus.Intraoperatively,guide wire,balloon dilation,stone extraction basket,stone removal with flushing catheter and stone removal with drainage catheter were employed according to different situations.The effect of stone removal and incidence of postoperative complications were observed.Results Among 26 patients,16 cases presented with stricture of the bile duct opening,4 cases with acute angle between the bile duct and choledochoscope and 6 cases with distal bile duct stones.All patients successfully completed choledochoscopic stone removal with a stone removal rate 92%(24/26).Transient bleeding of biliary tract occurred in 4 patients intraoperatively,which were healed spontaneously without special treatment.Postoperative fever was observed in 6 cases and they were cured by antibiotics and symptomatic treatments.No severe complications occurred.Conclusions Ultrasound-guided choledochoscopy via the T-tube sinus is an accurate,rapid and convenient procedure,which can remove intrahepatic bile duct stones to the greatest extent and shorten the operation time.Moreover,it can be performed repeatedly for stone removal.