经皮持续灌洗胆镜治疗原发性胆管结石的临床评价

Clinical evaluation on treatment of primary cholelithes with percutaneous continuous irrigation cholelithoscope

目的 探索经皮持续灌洗胆镜 (PCIC)治疗肝内胆管结石及狭窄的可行性及临床价值。方法 采用PCIC分别经胆总管切开入路 ,左肝外侧叶切除后断面胆管入路 ,T管瘘道 ,小剖腹左肝胆管入路及胆肠Roux en Y吻合皮下肠袢等多途径治疗原发性胆管结石 372例。结果 经上述途径入镜 ,结石取净率分别为 99% ,10 0 % ,97% ,10 0 %及 10 0 %。总的结石取净率为 99 2 %。对 94例合并胆管狭窄病人 ,经PCIC即时扩张或扩张加支撑管治疗 ,狭窄全部解除。随访 15个月至 6年 ,无症状及结石复发。结论 PCIC治疗原发性胆管结石方法简便 ,疗效肯定。

Objective To study the feasibility and clinical value of percutaneous continuous irrigation cholelithoscope (PCIC) in treatment of cholelithes bile duct stricture in the liver. Methods A total of 372 patients with primary cholelithes were treated with PCIC in our hospital. The routes for insertion of PCIC were incision on the choleduches, hepatic duct of the cross-section after left lateral lobectomy of the liver, T-tube fistula, the left hepatic duct following lesser laparotomy and the blind-loop of Roux-en-Y choledochojejunostomy. Results The stone-clearing rate was 99%, 100%, 97%, 100% and 100%, respectively, with insertion through the above-mentioned routes and the average rate was 99.2%. Ninety-four patients complicated with stricture of bile duct were treated with PCIC plus dilation with supporting-tube. All the strictures were released. The follow-up check for 15 months to 6 years showed no symptoms or recurrence. Conclusions PCIC is convenient in treating primary cholelithes and has definite therapeutic effects.