胆道术后残余结石及再生结石的内镜治疗

Endoscopic therapy for regenerated and residual stone after bile duct operation

目的 探讨胆道镜、十二指肠镜治疗胆道术后残余结石及再生结石的疗效。方法 回顾性分析 1995～ 2 0 0 3年 ,经T管窦道胆道镜治疗 76 3例 ,经皮下盲袢胆道镜治疗 2 5例 ,经皮经肝胆道镜治疗 33例 ,经十二指肠镜治疗 5 0 4例的经验。结果 经T管窦道胆道镜结石取净率 94 2 % ,经皮下盲袢胆道镜结石取净率 92 % ,经皮经肝胆道镜成功率 87 9%、结石取净率 81 8% ,经十二指肠镜胆道造影成功率 94 4 % ,其中取石成功率89 2 % ,一次结石取净率 82 3% ,两次结石取净率 86 6 %。结论 胆道镜、十二指肠镜治疗胆道术后残余结石及再生结石、有效、安全、微创可作为临床首选的方法。

Objective To discuss the therapeutic effects of choledochoscope and duodenoscope on regenerated and residual stone after bile duct operation. Methods Retrospective analysis of the patients' data collected from 1995 to 2003 was made, including 763 cases treated by choledochoscopy per T-tube sinus tract, 25 cases by choledochoscopy per subcutaneous blind loop, 33 cases by percutaneous transhepatic choledochoscopy, 504 cases by duodenoscopy. Results Rate of stone completely taken by choledochoscopy per T-tube sinus tract was 94.2% and that by choledochoscopy per subcutaneous blind loop was 92%. Rate of successful stone taken by percutaneous transhepatic choledochoscopy was 87.9%, rate of stone completely taken by it was 81.8%. Success rate of cholangiography per duodenoscopy was 94.4%, successful stone taken rate was 89.2%, rate of one time stone completely taken was 82.3%,twice rate was 86.6%. Conclusion Treatment with choledochoscopy and duodenoscopy is the first choice for regenerated and residual stone after bile duct operation, and it is an effective, safe and microinvasive method.