内镜逆行胰胆管造影联合eyeMax胆胰成像系统直视下液电碎石治疗困难胆管结石效果观察

Efficacy of endoscopic retrograde cholangiopancreatography combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in treatment of difficult choledocholithiasis

目的探讨内镜逆行胰胆管造影(ERCP)联合eye Max胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石的安全性及有效性。方法回顾性分析2022年5月—11月吉林市人民医院消化内科行ERCP联合eye Max胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石12例患者的临床资料,观察碎石、取石的临床效果,评估术后并发症发生情况,以及手术操作时间。结果12例患者中,11例(91.67%)患者直视液电碎石成功,9例(75.00%)一次性取石成功,11例(91.67%)达到结石完全清除,1例患者因多次胆道手术造成胆管多处狭窄,直视下将狭窄处上方的Ⅱ级肝内胆管结石取出,但仍残留Ⅲ级肝内胆管结石,进而未能达到结石完全清除的效果;ERCP平均操作时间(91.3±26.2)min,其中能量碎石时间为(41.8±22.2)min;术后2例胆道感染,给予抗感染后好转;2例高淀粉酶血症,未予特殊处置;3例轻度胰腺炎,给予药物对症治疗后好转;无出血、穿孔等并发症。结论ERCP联合eyeMax胆胰成像系统直视下应用液电碎石技术治疗困难胆管结石安全、有效、可行。

Objective To investigate the safety and efficacy of endoscopic retrograde cholangiopancreatography(ERCP)combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in the treatment of difficult choledocholithiasis.Methods A retrospective analysis was performed for the clinical data of 12 patients with difficult choledocholithiasis who underwent ERCP and electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in Department of Gastroenterology,Jilin People’s Hospital,from May to November 2022.The clinical effect of lithotripsy and lithotomy was observed,and postoperative complications and time of surgical operation were assessed.Results Among the 12 patients,11(91.67%)were successfully treated by electrohydraulic lithotripsy under direct view,9(75.00%)achieved firstattempt success in lithotripsy,and 11(91.67%)had complete removal of calculi;1 patient was found to have stenosis of the bile ducts caused by multiple biliary tract surgeries,and gradeⅡintrahepatic bile duct stones above the sites of stenosis were removed under direct view,but there were still residues of gradeⅢintrahepatic bile duct stones,which led to the fact that complete calculus removal was not achieved.The mean time of ERCP operation was 91.3±26.2 minutes,including a time of 41.8±22.2 minutes for energy lithotripsy.There were 2 cases of postoperative biliary tract infection which were improved after anti-infective therapy,2 cases of hyperamylasemia which were not given special treatment,and 3 cases of mild pancreatitis which were improved after symptomatic medication,and there were no complications such as bleeding and perforation.Conclusion ERCP combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system is safe,effective,and feasible in the treatment of difficult choledocholithiasis.