顺行球囊推石治疗胆道取石T管引流术后肝外胆管残留结石的病例报道

Antegrade balloon push stone treatment for biliary stone extraction T tube Case report of the extrahepatic bile duct residual stones 21 days after the drainage procedure

目的总结顺行球囊推石技术治疗胆道探查取石T管引流术后肝外胆管残留结石的经验。方法1例72岁男性病人,门诊以胆道探查取石T管引流术后21天,上腹剧痛10小时为主诉收住入院,完善胆道磁共振检查提示T管在位,胆总管下段多发结石。诊断为胆道取石T管引流术后,肝外胆道残留结石。经多学科诊疗讨论,急诊行局麻下经数字减影血管造影引导T管窦道顺行球囊推石手术治疗。术中将肝外胆管残留结石全部推入十二指肠内,并经导丝重新留置T管引流。结果病人手术后第3天出院,第7天拔除T管引流,窦道自愈,随访1个月无不适症状。结论顺行球囊推石技术治疗胆道探查取石T管引流术后窦道未完全成熟时肝外胆管残留结石具有一定的可行性,可作为再次手术、经T管窦道胆道镜取石和经内镜逆行性胰胆管造影取石的替选方案。

Objective Exploring the feasibility of the cascade balloon pushing technique for the treatment of residual extrahepatic bile duct stones in the early period(3~4 weeks)after choledocholithotomy T-tube drainage.Methods A 72-year-old male patient was admitted to the hospital with the complaint“21 days after T-tube drainage for biliary tract exploration and severe epigastric pain for 10 hours”.After MDT discussion,a digital subtraction angiography-guided T-tube fistula with paralleling balloon pushing was performed under local anesthesia as an emergency treatment.All residual extrahepatic biliary stones were pushed into the duodenum and the T-tube was reintroduced via a guidewire for drainage.Result The patient was discharged on the 3rd day after surgery and the T-tube was removed on the 7th day.The sinus tract healed spontaneously and was followed up for 1 month without discomfort.Conclusion The cascade balloon pushing technique is feasible for the treatment of residual extrahepatic bile duct stones in the early stages after choledocholithotomy T-tube drainage and can be used as an alternative to return to surgical stone extraction,trans-T-tube sinusoidal choledochoscopy or trans-endoscopic retrograde cholangiopancreatography for stone extraction.