胆道镜治疗术后肝内胆管结石合并胆管狭窄230例临床体会

摘要

Objective To investigate the value of choledochoscopy in the treatment of intrahepatic bile duct stones complicated by biliary stricture,treatment methods,and related complications.Methods A retrospective analysis was performed for the clinical data of 230 patients with intrahepatic bile duct stones complicated by biliary stricture who underwent choledochoscopy in Jiangning Hospital Affiliated to Nanjing Medical University from June 2015 to May 2017.The treatment timing and duration of choledochoscopy,number of times of stone removal,and intraoperative complications were observed,and the patients were followed up for 1-3 months to observe residual stones,T tube detachment,and postoperative gastrointestinal reactions.Results Of all patients,229 had benign biliary stricture and 1 had malignant biliary stricture found by choledochoscopy.A total of 692 person-times of choledochoscopy were performed,and the patients underwent 2-7 times of choledochoscopy (mean 3.9 ± 1.1).Each time of choledochoscopy lasted for 25-60 minutes (mean 40.9 ± 11.5 minutes).Choledochoscopy was performed during 90-120 days after surgery (mean 105.0-± 9.5 days).Eight patients experienced T tube detachment,and six of them underwent successful T tube replacement.Of all patients,4 had residual stones after choledochoscopy,resulting in a residual stone rate of 1.73％.There were 83 person-times of postoperative complications including pyrexia,nausea,and diarrhea,which were relieved after symptomatic treatment.Conclusion Choledochoscopy is an important supplemental therapy for the surgical treatment of intrahepatic bile duct stones complicated by biliary stricture and has the features of high efficiency,small trauma,and rapid recovery.Therefore,it holds promise for clinical application.%目的 探讨胆道镜治疗在术后肝内胆管结石合并胆管狭窄中的应用价值、处理方法及相关并发症.方法 回顾性分析2015年6月-2017年5月南京医科大学附属南京江宁医院应用胆道镜治疗肝内胆管结石合并胆管狭窄的230例患者的临床资料.观察分析胆道镜治疗时机、持续时间、取石次数、术中相关并发症,并随访1～3个月,观察结石残余、T管滑脱、术后消化道反应等指标.结果 230例患者中经胆道镜检查发现229例合并良性胆管狭窄,1例合并恶性胆管狭窄.总共实施胆道镜检查692人次,患者接受胆道镜检查2～7次,平均(3.9±1.1)次.每次胆道镜检查持续时间25 ～60 min,平均(40.9±11.5)min.术后胆道镜治疗时间为术后90 ～120 d,平均(105.0±9.5)d.T管滑脱8例,成功重置T管6例.胆道镜治疗后残石4例,残石率1.73％;术后并发发热、恶心或腹泻等症状共83人次,对症处理后均缓解.结论 胆道镜是对肝内胆管结石合并胆管狭窄患者外科治疗的重要补充,具有高效、创伤小、恢复快等特点,值得进一步推广.