经胆道镜冲击波碎石治疗胆道残余结石的体会（附75例报告）

目的探讨应用体内冲击波碎石机，经胆道镜碎石治疗手术后胆道残余结石的疗效和安全性。方法对我院2009年8月至2010年3月间75例带T管胆道残余结石的患者，在胆道镜直视下，应用冲击波碎石机将结石击碎后，用取石篮取出，并用生理盐水反复冲洗胆道。结果75例中31例1次取净结石（占41．3％），35例2次取净（46．7％），9例3次以上取净（12％）。取石成功率100％，取石次数1—3次，平均1．7次，无胆道穿孔等严重并发症，有12例（10％）患者发生术中胆道少量出血，2例（2．7％）患者呕吐，5例（6．7％）患者术中有疼痛感，均经保守治疗后缓解。结论体内冲击波碎石机与胆道镜配合，将能窥见的难取性胆道残留结石击碎取出，安全易行，疗效确切，大大提高了取石成功率，值得临床广泛推广应用。

Experience of clinical application of choledochoscopy-assisted intraductal shock wave lithotripsy in treatment of residual bile duct stones(a report of 75 cases)

Objective To explore the efficacy and safety of choledochoscopy - assisted intraductal shock wave lithotripsy in the treatment of residual bile duct stones. Methods From August 2009 to March 2010,shock wave lithotripsy were used to removed the bile stones under the choledochoscope in the patients（ n = 75）who had residual bile duct stones and given T- tube drainage post- operation. Reticular basket was adopted to take out the stones and normal saline used to irrigate the ducts. Results Among the 75 cases,stones were completely removed for the first attemp in 31 cases（41.3% ） ,for the second attemp in 35 cases（46.7% ）and for the third attemp in 9 cases（ 12% ）. The success rate reached 100%. The number of stone removal ranged from 1 to 3 with an average of 1.7. No bile duct perforation was found in this cohort. 12 patients （10%）developed mild biliary tract bleeding during the operations,2 （2.7%）had vomiting, and 5 reported （6.7 % ）pain during the operations. All the complications were relieved after conservative treatment. Conclution Choledochoscopy - assisted intraductal shock wave lithotripsy is effective and safe in the treatment of refractory biliary calculi.