胆道镜联合液电碎石治疗难取性肝内外胆管结石

摘要

Objective To investigate the therapeutic effect and safety of cholangioscopy combined with electrohydraulic shockwave lithotripsy for refractory bile duct lithiasis. Methods Clinical data of 38 patients with refractory bile duct lithiasis who were treated with cholangioscopy combined with electrohydraulic shockwave lithotripsy between March 2009 and February 2014 were retrospectively analyzed.There were 27 patients treated during common bile duct exploration and 11 patients treated postoperatively via T-tube fistula. Results Of the 38 cases, stones were completely removed in 36 cases, with a clearance rate of 94.7%.Residual stones occurred in 2 cases (5.3%).There were 63 times of electrohydraulic shockwave lithotripsy (once in 18 cases, twice in 15 cases, and 3 times in 5 cases) and 81 times of cholangioscopy ( once in 10 cases, twice in 18 cases, 3 times in 5 cases, and 4 times in 5 cases) .No serious complications happened, such as massive biliary bleeding, perforation, and iatrogenic pancreatitis.Follow-up observations were performed in 38 patients for 6 to 36 months ( mean, 24 months) and no recurrent stones or biliary strictures were noted. Conclusion Cholangioscopy combined with electrohydraulic shockwave lithotripsy is safe and effective for refractory bile duct lithiasis.%目的：探讨胆道镜下液电碎石治疗难取性胆管结石的疗效和安全性。方法回顾性分析2009年3月～2014年2月38例难取性胆管结石术中和（或）术后应用胆道镜联合液电碎石治疗的临床资料，其中胆总管探查术中应用27例，胆道术后经T管窦道应用11例。结果结石取净率94．7％（36／38），结石残留2例。应用液电碎石63次（1次18例，2次15例，3次5例），纤维胆道镜81次（1次10例，2次18例，3次5例，4次5例）。无胆管壁穿孔、大出血及医源性胰腺炎等并发症发生。38例术后随访6～36个月，平均24个月，CT检查均未见结石复发及胆管狭窄。结论针对难取性胆管结石，胆道镜联合液电碎石是一种安全、有效的方法。