经皮穿刺空肠-胆管取石术在胆肠吻合术后狭窄伴结石中的应用(附18例报告)

Application of percutaneous jejunal puncture in the treatment of bile duct stones after choledochoenterostomy(Report of 18 cases)

目的探讨一种新颖的胆肠吻合术后狭窄伴结石的治疗方法。方法经皮肝穿胆管引流术(percutaneous transhepatic cholangial drainage,PTCD)控制胆系感染,CT下确定空肠的经皮穿刺部位,肠管充气状态下穿刺置入8.5F导管固定,1个月后经此窦道透视下取石网篮取出胆管取石,取净胆管结石后予14F引流管支撑胆肠吻合口1年。结果完成经皮穿刺空肠行胆道取石18例,17例通过一次或多次透视下取尽结石,1例经3次取石不尽后转空肠窦道胆道镜取石成功,未出现明显出血、肠瘘、胆瘘及腹腔感染等并发症。随访期内复查未见复发结石,胆肠吻合口通畅。结论经皮穿刺空肠-胆管取石术是一种实用可行的治疗胆肠吻合术后胆肠吻合口狭窄伴结石的方法,可局麻操作,安全性高,并发症少,对麻醉及全身状况要求低,适应证广泛。

Objective To explore a novel technique for stone extraction of bile duct stones after choledochoenterostomy.Methods Using PTCD to control the biliary infection.The site of percutaneous jejunum puncture was determined by CT.The jejunum was punctured in the dilated state,and 8.5F catheter was placed and fixed.After 1 month,take out the bile duct stones with the stone basket through this sinus under fluoroscopy.After removing the bile duct stones,give 14F drainage tube to support the choledochojejunostomy for 1 year.Results Removal of bile duct stones were performed in 18 cases by the way of percutaneous jejunal puncture.17 cases were removed completely by one or more fluoroscopy,and 1 case was transferred to the jejunal sinus choledochoscopy after three times of incomplete stone extraction,without obvious complications such as hemorrhage,intestinal fistula,biliary fistula and abdominal infection.During the follow-up period,no stone was found,and the biliary and intestinal anastomosis was unobstructed..Conclusions Percutaneous jejunal puncture for removal of bile duct stones is a feasible,safe and effective method for the treatment of bile duct stones after choledochoenterostomy.