液电碎石取石术治疗胆道难取性结石12例临床分析

Electrohydraulic lithotripsy for the treatment of intractable biliary stones in 12 cases

目的:探讨采用液电碎石法 (EHL)治疗胆道难取性结石的临床价值及适应证。 方法 :采用液电碎石法 ,在纤维胆道镜的直视下 ,用液电碎石电极头将胆总管、肝总管或肝内胆管内嵌顿的或较大结石击碎后 ,用取石网篮全部取出。结果:12例病人中 ,11例一次取净 ,1例在操作中出现高热、寒战 ,对症治疗后好转 ,行 2次碎石而取净 ,无胆道出血和穿孔等并发症 ,无死亡病例。结论 :液电碎石取石术是治疗胆道难取性结石一种安全、可靠、有效的方法 ,EHL的应用可以缩短取石时间 ,减少反复多次胆道镜取石 ,提高胆石的取净率 。

Objective: To explore therapeutic method for biliary stones, which were too difficult to be removed by routine ways. We want to study the clinic value and accommodation of EHL for intractable biliary stones. Methods: Electrohydraulic lithotripsy (EHL) was employed. The stones incarcerated in common bile duct, hepatic or intrahepatic duct should be broken into pieces by using the electrohydraulic lithotrite at first step, especially for the too big sized stones. Then, the stones can be taken out entirely with a netlike basket. All the above procedures were done under direct vision with biliary endoscopy. Results: One case occurred hyperpyrexia and chills when operated, and was removed secondly after being cared to take a turn for the batter. Other 11 cases were cured and their biliary stones were taken out completely at the first time without hemorrhage and perforation (no dead case). Conclusion: EHL could be considered as an safe, reliable and effective treatment for biliary stones which can not be easily removed. When the stones are bigger or incarcerated, it would be possible to reduce the time of removing and avoid further repeated operation by choledochoscope if employed by EHL.