ESWL for difficult bile duct stones:A 15-year single centre experience

AIM:To evaluate the efficacy of extracorporeal shock wave lithotripsy(ESWL)for the management of refractory bile duct cholelithiasis in a third level referral centre.METHODS:The clinical records of all patients treated with a second generation electromagnetic lithotripter (Lithostar Plus,SIEMENS)from October 1990 to April 2005 were evaluated.All patients were monitored during the procedure and antibiotics were administered in case of cholangitis.Theχ 2 test and logistic regression analysis were performed as appropriate.RESULTS:Two hundred and fourteen patients(102 males,112 females;mean age 74.8±0.84 years-single stone 97,multiple stones 117)underwent ESWL.The mean number of sessions and shock waves were 3.5 ±0.13 and 3477.06±66.17,respectively.The maximum stone size was 5 cm.Complete stone clearance was achieved in 192(89.7%)patients.Of the remain-ing patients 15 required surgery,2 a palliative stent and in 5 patients stone fragmentation led to effective bile drainage with clinical resolution despite incomplete clearance.Age,sex and stone characteristics were not related to treatment outcome.Major complications occurred in two patients(haemobilia and rectal bleeding) and minor complications in 25(3 vomiting,22 arrhythmias).No procedure-related deaths occurred.CONCLUSION:ESWL is a safe and effective technique for clearance of refractory bile duct stones.

Immediate balloon deflation method in endoscopic papillary large balloon dilation for extraction of difficult bile duct stones

Background/Aims: Recently, endoscopic papillary large balloon dilation (EPLBD) using a large balloon (12 - 20 mm) for extraction of difficult common bile duct (CBD) stones has been widely accepted with favorable outcomes. However, there is no consensus with regard to the ballooning time. The aim of our study was to evaluate the efficacy and safety of immediate balloon deflation in EPLBD for the treatment of difficult bile duct stone. Methods: This was a retrospective study of 80 consecutive patients with bile duct stones who were treated with an immediate balloon deflation method in EPLBD combined with endoscopic sphincterotomy (EST) between January 2010 and December 2012. Overall success rate, success rate at first ERCP, and the frequency of mechanical lithotripsy for complete stone removal were assessed for efficacy and safety was evaluated by assessing major complications. Results: Overall success rate for complete stone removal was high (78/80, 97.5%) and success rate for complete stone removal at first ERCP was 86.3% (69/80). The use of mechanical lithotripsy was 0% (0/80). The overall complication rate was favorable (5/80, 6.3%). PostERCP pancreatitis was observed in 3 patients (two: mild, one: moderate). In subgroup analysis, the presence of periampullary diverticulum was the only factor affecting the success rate at first ERCP. Conclusion: This study demonstrated the favorable outcome of immediate balloon deflation for treatment of difficult CBD stones and can be considered for clinical application.

Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence

While endoscopic retrograde cholangiopancreatography(ERCP)remains the primary treatment modality for common bile duct stones(CBDS)or choledocho-lithiasis due to advancements in instruments,surgical intervention,known as common bile duct exploration(CBDE),is still necessary in cases of difficult CBDS,failed endoscopic treatment,or altered anatomy.Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes.This review elucidates relevant clinical anatomy,selection indications,and outcomes to enhance surgical understanding.The selection between trans-cystic(TC)vs trans-choledochal(TD)approaches is described,along with stone removal techniques and ductal closure.Detailed surgical techniques and strategies for both the TC and TD approaches,including instrument selection,is also provided.Additionally,this review comprehensively addresses operation-specific complications such as bile leakage,stricture,and entrapment,and focuses on preventive measures and treatment strategies.This review aims to optimize the management of CBDS through laparoscopic CBDE,with the goal of improving patient outcomes and minimizing risks.

Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

BACKGROUND Current guidelines recommend not performing papillary large balloon dilation in patients with nondilated distal bile ducts.AIM To assess the feasibility of balloon dilation to remove difficult stones in patients with nondilated distal bile ducts.METHODS Data from 1289 endoscopic retrograde cholangiopancreatography(ERCP)procedures were obtained from two prospective studies.While 258 cases had difficult stones(>1 cm,multiple>8,impacted,or having a thin distal duct),191 underwent biliary dilation up to 15 mm after endoscopic sphincterotomy.Cholangiographies of these cases were retrospectively reviewed in order to classify the distal bile duct and both the stone size and number.Primary outcomes were clearance rate at first ERCP and complications.RESULTS Of the 191 patients(122 women and 69 men;mean age:60 years)who underwent biliary dilation for difficult stones,113(59%)had a nondilated or tapered distal duct.Patients with a dilated distal duct were older than those with nondilated distal ducts(mean 68 and 52 years of age,respectively;P<0.05),had more stones(median 4 and 2 stones per patient,respectively;P<0.05),and had less need for additional mechanical lithotripsy(6.4%vs 25%,respectively;P<0.05).Clearance rate at first ERCP was comparable between patients with a dilated(73/78;94%)and nondilated distal ducts(103/113;91%).Procedures were faster in patients with a dilated distal duct(mean 17 vs 24 min,respectively;P<0.005).Complications were similar in both groups(6.4%vs 7.1%,respectively).CONCLUSION Large balloon dilation for difficult stones is feasible in patients with a nondilated or even tapered distal duct.

Innovation of endoscopic management in difficult common bile duct stone in the era of laparoscopic surgery

Common bile duct(CBD)stone is a common biliary problem,which often requires endoscopic approach as the initial treatment option.Roughly,7%-12%of the subjects who experience cholecystectomy were subsequently referred to biliary endoscopist for further management.In general,there are three classifications of difficult CBD stone,which are based on the characteristics of the stone(larger than 15 mm,barrel or square-shaped stones,and hard consistency),accessibility to papilla related to anatomical variations,and other clinical conditions or comorbidities of the patients.Currently,endoscopic papillary large balloon dilation(EPLBD)of a previous sphincterotomy and EPLBD combined with limited sphincterotomy performed on the same session is still recommended by the European Society of Gastrointestinal Endoscopy as the main approach in difficult CBD stones with history of failed sphincterotomy and balloon and/or basket attempts.If failed extraction is still encountered,mechanical lithotripsy or cholangioscopy-assisted lithotripsy or extracorporeal shockwave lithotripsy can be considered.Surgical approach can be considered when stone extraction is still failed or the facilities to perform lithotripsy are not available.To our knowledge,conflicting evidence are still found from previous studies related to the comparison between endoscopic and surgical approaches.The availability of experienced operator and resources needs to be considered in creating individualized treatment strategies for managing difficult biliary stones.

Poorly expandable common bile duct with stones on endoscopic retrograde cholangiography

AIM:To describe characteristics of a poorly expandable(PE) common bile duct(CBD) with stones on endoscopic retrograde cholangiography.METHODS:A PE bile duct was characterized by a rigid and relatively narrowed distal CBD with retrograde dilatation of the non-PE segment.Between 2003 and 2006,endoscopic retrograde cholangiography(ERC) images and chart reviews of 1213 patients with newly diagnosed CBD stones were obtained from the computer database of Therapeutic Endoscopic Center in Chang Gung Memorial Hospital.Patients with characteristic PE bile duct on ERC were identified from the database.Data of the patients as well as the safety and technical success of therapeutic ERC were collected and analyzed retrospectively.RESULTS:A total of 30 patients with CBD stones and characteristic PE segments were enrolled in this study.The median patient age was 45 years(range,20 to 92 years);66.7% of the patients were men.The diameters of the widest non-PE CBD segment,the PE segment,and the largest stone were 14.3 ± 4.9 mm,5.8 ± 1.6 mm,and 11.2 ± 4.7 mm,respectively.The length of the PE segment was 39.7 ± 15.4 mm(range,12.3 mm to 70.9 mm).To remove the CBD stone(s) completely,mechanical lithotripsy was required in 25(83.3%) patients even though the stone size was not as large as were the difficult stones that have been described in the literature.The stone size and stone/PE segment diameter ratio were associated with the need for lithotripsy.Post-ERC complications occurred in 4 cases:pancreatitis in 1,cholangitis in 2,and an impacted Dormia basket with cholangitis in 1.Two(6.7%) of the 28 patients developed recurrent CBD stones at follow-up(50 ± 14 mo) and were successfully managed with therapeutic ERC.CONCLUSION:Patients with a PE duct frequently require mechanical lithotripsy for stones extraction.To retrieve stones successfully and avoid complications,these patients should be identified during ERC.

PTCD引导下体外震波碎石联合ERCP治疗改道术后困难胆管结石2例

背景经内镜逆行胰胆管造影术(endoscopic retrograde cholan-gio pancreatography,ERCP)是目前治疗胆管结石的常规手段,但对于改道术后的患者,由于乳头位置改变、胆管插管困难等原因,ERCP成功率有所下降,需探索更为合适的治疗方案.病例简介本文报道2例改道术后的困难胆管结石,在经经皮肝穿刺胆道引流术(percutaneous transhepatic cholangio-graphy drainage,PTCD)引导下进行体外震波碎石(ex-tracorporeal shock wave lithotripsy,ESWL)联合ERCP治疗,取得良好的治疗效果.结论对于一些高龄、基础条件差的困难胆管结石患者,常规ERCP失败后可尝试使用PTCD解除梗阻、充分引流,待一般情况好转后,择期ESWL联合ERCP取石,可取得不错的治疗效果.

ERCP联合SpyGlass DS治疗困难胆管结石的临床疗效评价及预后评价

目的评价内镜逆行胰胆管造影术(ERCP)和ERCP+SpyGlass DS治疗困难胆管结石的临床疗效及预后。方法回顾性分析北京中医药大学东方医院内镜中心2020年1月至2023年6月收治的共80例行ERCP、ERCP+SpyGlass DS治疗的困难胆总管结石患者的临床资料,利用倾向性评分匹配法找到与ERCP+SpyGlass DS组病例匹配度最高的ERCP组病例,每组纳入40例患者,比较两组手术治疗情况、术后体温和症状及手术相关指标。结果两组患者手术操作时间差异有统计学意义(P<0.05),两组患者住院天数、一次取石成功率、需要进行二次取石率,差异均无统计学意义(P>0.05);ERCP组术后发热患者占5.0%(2/40)、持续性腹痛患者占7.5%(3/40)、右上腹出现新腹痛患者占10.0%(4/40)、呕血患者占0%(0/40)、黑便患者占7.5%(3/40);ERCP+SpyGlass DS组术后发热患者占2.5%(1/40)、持续性腹痛患者占0%(0/40)、右上腹出现新腹痛患者占0%(0/40)、呕血患者占0%(0/40)、黑便患者占5.0%(2/40);两组患者AMY下降率、CRP下降率、术前白细胞计数、白细胞计数下降率、术前TBIL水平、TBIL下降率、术前DBIL水平,差异有统计学意义(P<0.05)。两组患者术前AMY水平、术后24 h AMY水平、术前CRP、术后24 h CRP水平、术后24 h白细胞计数、术后TBIL水平、术后DBIL水平、DBIL下降率,差异均无统计学意义(P>0.05)。结论ERCP与ERCP+SpyGlass DS治疗困难胆管结石均安全可靠。ERCP联合SpyGlass DS临床疗效良好,预后积极,值得进一步推广。

内镜下胆管塑料支架内引流治疗难取性胆总管结石

目的探讨塑料支架内引流(ERBD)术治疗难取性胆总管结石的疗效。方法采用常规方法行经内镜逆行胰胆管造影(ERCP)造影,对48例胆总管难取性结石患者在导丝引导下置入8.5F塑料胆管内支架1、2根,并随访6～18个月。结果 6个月后B超复查时发现38例患者结石直径变小或成碎片状,第2次ERCP经网篮或气囊顺利取出;10例结石无明显变化,B超随访,一旦发现结石明显变小,即再次ERCP+取石;经平均2.5次内镜下治疗,95.8%(46/48)患者结石取净。期间未发生与ERCP或留置支架相关的严重并发症。结论留置塑料内支架是治疗难取性胆总管结石简单有效的方法。

塑料内支架在难取性胆总管结石中的应用

目的评价塑料内支架治疗难取性胆总管结石的疗效。方法采用常规方法行ERCP造影,对48例难取性胆总管结石患者(35例为巨大结石,8例结石伴下端胆管狭窄,5例结石伴乳头过小)在导丝引导下行放置8.5F塑料胆道内支架1根治疗。结果3个月后第2次ERCP检查时发现12例结石消失;23例结石直径变小1/2以上或成碎片状,经网篮或气囊顺利取出;13例结石无明显变化,行更换塑料内支架治疗并B超随访,一旦发现结石明显变小,即再次ERCP+取石。经平均2.3次内镜下治疗,95.8%(46/48)患者结石取净。期间未发生与ERCP或留置支架相关的严重并发症。结论留置塑料内支架是治疗难取性胆总管结石简单有效的方法。

Peroral cholangioscopy:Update on the state-of-the-art

Peroral cholangioscopy(POC)is an endoscopic procedure that allows direct intraductal visualization of the biliary tract.POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of difficult biliary stones.Over several generations of devices,POC has fulfilled additional clinical needs where other diagnostic or therapeutic modalities have been inadequate.With adverse event rates comparable to standard endoscopic retrograde cholangioscopy and unique technical attributes,the role of POC is likely to continue expand.In this frontiers article,we highlight the existing and growing clinical applications of POC as well as areas of ongoing research.

塑料内支架治疗难取性胆总管结石的疗效分析

目的评价塑料内支架治疗难取性胆总管结石的疗效。方法采用常规方法行ERCP造影,对58例难取性胆总管结石患者(41例为巨大结石,10例结石伴下端胆管狭窄、7例结石伴乳头过小),在导丝引导下放置一根8.5Fr塑料胆道内支架进行治疗。结果3个月后第二次ERCP检查时,发现15例结石消失;27例结石直径变小1/2以上或成碎片状经网篮或气囊顺利取出;16例结石无明显变化,行更换塑料内支架治疗并B超随访,一旦发现结石明显变小,即再次ERCP+取石。经平均2.3次内镜下治疗,96.5%患者结石取净。期间未发生与ERCP或留置支架相关的严重并发症。结论留置塑料内支架是治疗难取性胆总管结石简单有效的方法。

塑料内支架治疗老年难取性胆总管结石的临床应用

目的探讨内镜下逆行胰胆管造影（ERCP）下胆管内引流术（ERBD）放置塑料支架治疗老年难取性胆总管结石伴梗阻的疗效、安全性及可行性。方法常规方法行ERCP造影，对31例难取性老年胆总管结石患者（28例为巨大结石，憩室内乳头和乳头旁憩室5例，胆总管下端炎性狭窄和小乳头11例；11例伴有严重基础疾病）；在导丝引导下放置1～2根7～8．5F塑料胆道内支架进行治疗。结果31例患者手术全部成功，手术时间平均约15min，术后患者1周内腹痛缓解、发热消退及黄疸明显减轻。随访3～36个月，1例支架脱落．2例支架堵塞；20例结石有不同程度缩小，7例结石大小无变化，4例结石增多或增大。31例中有10例行2次ERCP取石成功，3例一般情况好转后行手术治疗。无ERCP或留置支架相关严重并发症。结论胆道塑料支架治疗老年人难取性胆总管结石操作简单、费用低、并发症少、疗效满意。对高危不宜再次介入或外科手术的患者，既解除了结石引起的胆道梗阻，又可作为一种长期的治疗手段，而且保留了奥狄氏括约肌功能，是一种较好的治疗方法。

Is endoscopic papillary large balloon dilatation without endoscopic sphincterotomy effective?

AIM: To evaluate the safety and efficacy of endoscopic papillary large balloon dilatation(EPLBD) without endoscopic sphincterotomy in a prospective study.METHODS: From July 2011 to August 2013, we performed EPLBD on 41 patients with nae papillae prospectively. For sphincteroplasty of EPLBD,endoscopic sphincterotomy(EST) was not performed,and balloon diameter selection was based on the distal common bile duct diameter. The balloon was inflated to the desired pressure. If the balloon waist did not disappear, and the desired pressure was satisfied, we judged the dilatation as complete. We used a retrieval balloon catheter or mechanical lithotripter(ML) to remove stones and assessed the rates of complete stone removal, number of sessions, use of ML and adverse events. Furthermore, we compared the presence or absence of balloon waist disappearance with clinical characteristics and endoscopic outcome.RESULTS: The mean diameters of the distal and maximum common bile duct were 13.5 ± 2.4 mm and16.4 ± 3.1 mm, respectively. The mean maximum transverse-diameter of the stones was 13.4 ± 3.4mm, and the mean number of stones was 3.0 ± 2.4.Complete stone removal was achieved in 97.5%(40/41)of cases, and ML was used in 12.2%(5/41) of cases.The mean number of sessions required was 1.2 ± 0.62.Pancreatitis developed in two patients and perforation in one. The rate of balloon waist disappearance was73.1%(30/41). No significant differences were noted in procedure time, rate of complete stone removal(100% vs 100%), number of sessions(1.1 vs 1.3, P= 0.22), application of ML(13% vs 9%, P = 0.71),or occurrence of pancreatitis(3.3% vs 9.1%, P =0.45) between cases with and without balloon waist disappearance.CONCLUSION: EST before sphincteroplasty may be unnecessary in EPLBD. Further investigations are needed to verify the relationship between the presence or absence of balloon waist disappearance.

ESWL联合ERCP治疗胆总管困难结石的护理

目的探讨对于胆总管困难结石的患者经体外冲击波碎石术(ESWL)联合内镜下胰胆管造影术(ERCP)治疗后的护理。方法选取2016年11月至2018年6月在浙江大学医学院附属杭州市第一人民医院消化内科经ESWL联合ERCP治疗的胆总管困难结石患者140例,从ESWL、ERCP、并发症和心理护理,以及出院指导等方面报告胆总管困难结石患者治疗后的护理方案。结果140例患者经过治疗及护理后,均痊愈出院。结论ESWL联合ERCP为胆总管困难结石患者提供了很好的一种治疗方法,做好相关护理工作,避免并发症的发生,促进患者健康。

内镜下单纯大柱状球囊扩张术治疗胆总管内大结石的安全评价

目的探讨内镜下单纯大柱状球囊扩张术治疗胆总管内大结石的安全性和有效性.方法对我院2016.01 ~2018.12期间采用内镜下单纯大柱状球囊扩张术(endoscopic papillary large balloon dilation,EPLBD)和内镜下乳头小切开+大柱状球囊扩张术(endoscopic minor sphincterotomy plus large balloon dilatation,EST+ EPLBD)进行治疗的胆总管内大结石患者的临床资料进行临床对照研究.结果 EPLBD组和EST+ EPLBD组总的结石清除率和一次结石清除率分别为100%(112/112);95.5%(107/112)和100%(87/87);96.6%(84/87),P均大于0.05,未见明显统计学差异.而前者机械碎石率和高淀粉酶血症发生率42.8%(48/112);33.0%(37/112)高于后者24.1%(21/87);19.5%(17/87),P<0.05,有统计学意义.两组术后急性胰腺炎(8/112,7.1%;6/87,6.8%)、消化道出血(2/112,1.8%;2/87,2.3%)和胆道感染(4/112,3.5%;3/87,3.4%)的并发症发生率未见明显统计学差异.两组均无穿孔和死亡病例.两组患者术后出现早期并发症的总例数分别为45.5%(51/112)和32.2%(28/87),P>0.05,无统计学差异.结论 EPLBD术治疗胆总管结石是安全可行的.但EPLBD术是否可以替代EST+ EPLBD术,尚需进一步的研究和探索.

ERCP联合SpyGlass DS直视下液电碎石治疗困难胆总管结石

目的:探讨内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)联合SpyGlass DS直视液电碎石治疗困难胆总管结石的有效性及安全性。方法:纳入2020年1月—2022年2月在杭州市第一人民医院行SpyGlass DS直视下液电碎石治疗的35例困难胆总管结石病人临床资料,分析碎石成功率、取石成功率、一次取石成功率以及术后并发症发生率、术后住院时间和ERCP操作时间。结果:34例(97.1%)SpyGlass DS直视液电碎石成功。1例液电碎石不完全,改为体外震波碎石。ERCP操作时间(77±13.1)min。所有病人最终均取石成功。29例(82.9%)一次取石成功。2例(5.7%)分别出现术后急性胆管炎、急性胰腺炎并发症。术后住院时间(6.3±3.7)d。结论:ERCP联合SpyGlass DS直视液电碎石治疗困难胆总管结石安全可行。

腹腔镜胆道镜联合钬激光治疗胆总管难取性结石的技术及效果分析

目的探讨腹腔镜、胆道镜联合钬激光治疗胆总管难取性结石的技术、安全性及效果.方法：回顾分析笔者所在医院2010 年1 月-2015 年1 月应用腹腔镜、胆道镜联合钬激光治疗31 例胆总管难取性结石的临床资料.结果：30 例患者均一次性碎石、取石成功,术后2 例胆漏,经T 管证实1 例胆总管缝合处渗漏,1 例T 管横臂呈弓状部分脱出,经延长腹腔引流管放置时间,术后15 d 左右自愈.术后5~6 周经T 管造影显示胆总管无残留结石、下端通畅后拔管.另外1 例结石嵌顿于胆总管下端,为70 岁男性胆囊结石并胆总管结石患者,术中患者血压、血氧波动较大,为了避免手术时间过长,仅作胆囊切除、T 管引流,术后6 周利用胆道镜经窦道行钬激光碎石,彻底冲出粉碎的细小结石,再次胆道镜检查显示无残留结石、胆总管下端通畅,置引流管,1 周后拔管.31 例患者均得到随访,随访时间2-12 个月,经B 超或MRCP 复查,未发现胆管残余结石或结石复发、无胆道狭窄.结论：腹腔镜、胆道镜联合钬激光碎石对胆总管难取性结石直观、准确、简化取石难度、疗效确切,未增加特殊副作用,是一种安全、可靠的腹腔镜下胆总管切开取石方法.

SpyGlass DS系统在临床诊疗中的应用研究进展

随着当今科学技术的革新,内镜诊疗技术也得到了突飞猛进的发展。2015年SpyGlass DS系统的出现将内镜诊疗带到了一个新的高度,其凭借成像清晰、视野宽广、性能优良等特点已成为胆胰系统疾病诊断与治疗的新生力量。本文就目前SpyGlass DS系统在临床诊断和治疗中的应用效果进行综述。

输尿管硬镜下结石清除术治疗肝胆管难取性结石效果探讨

目的探讨肝胆管难取性结石治疗中输尿管硬镜的临床应用价值。方法选取2020-02-15-2022-02-15枣庄市峄城区人民医院收治的60例肝胆管难取性结石患者为研究对象,依据手术方法分为经皮输尿管硬镜下结石清除术组(输尿管硬镜组)、纤维胆管镜下常规性开腹切开胆管取石术组(胆管镜组),各30例。分析2组净石、残石、再次手术情况,以及围术期指标、结石数目、疼痛程度、心理应激、生活质量、生理应激、肝胆功能、临床疗效、术后并发症发生情况。结果2组患者的净石率、残石率、再次手术率比较,差异无统计学意义,均P>0.05。输尿管硬镜组患者术中出血量为(80.75±11.76)mL,少于胆管镜组的(140.88±23.73)mL,t=12.436,P<0.001;肠功能恢复时间、住院时间分别为(1.98±0.34)、(7.64±1.51)d,短于胆管镜组的(3.77±0.72)、(11.98±2.87)d,t值分别为12.313和7.330,均P<0.001。输尿管硬镜组患者结石数目少于胆管镜组,视觉模拟评分(VAS)、焦虑评分、抑郁评分均低于胆管镜组,生活质量评分高于胆管镜组,血糖(GLU)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)、C反应蛋白(CRP)、白介素-6(IL-6)、可溶性肿瘤坏死因子受体(sTNFR)、直接胆红素(DBIL)、总胆红素(TBIL)、碱性磷酸酶(AKP)、天冬酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)水平均低于胆管镜组,均P<0.001。输尿管硬镜组患者总有效率为96.67%(29/30),高于胆管镜组的73.33%(22/30),χ^(2)=4.706,P=0.030。输尿管硬镜组患者的术后并发症发生率为6.67%(2/30),低于胆管镜组的26.67%(8/30),χ^(2)=4.320,P=0.038。结论肝胆管难取性结石治疗中经皮输尿管硬镜下结石清除术的临床价值较纤维胆管镜下常规性开腹切开胆管取石术高。