经皮肝径路胆胰镜下钬激光碎石术治疗胆管结石初探

目的探讨经皮肝胆管穿刺置管胆胰镜下钬激光碎石术治疗胆管结石的可行性。方法选取12例难以耐受手术或难以实施手术的肝内外胆管多发结石患者,经皮肝径路行胆胰镜下钬激光碎石术,术后行PTCD引流,CT提示胆总管无结石残留、无胆道梗阻后拔出PTCD管。结果 12例均顺利施行经皮肝胆胰镜下钬激光碎石术,手术时间1.0~3.5 h,平均2.5 h;5例行单次碎石术,6例行2次碎石术,1例行3次碎石术;1例术中出现发热反应,1例出现PTCD管脱落。结论经皮肝胆管穿刺置管胆胰镜下钬激光碎石术治疗肝内外胆管多发结石是一微创、安全、有效的术式。

Preliminary study on cholangiopancreatoscopic Holmium laser lithotripsy in percutaneoustran-shepatic path for the treatment of hepatolith

Objective To explore the feasibility of cholangiopancreatoscopic Holmium laser lithotripsy in percutaneous transhepatic path for the treatment of hepatolith. Methods A total of 12 hepatolith patients difficult for operation were treated with cholangiopancreatoscopic Holmium laser lithotripsy in percutaneous transhepatic path. The PTCD tube was placed in bile duct postoperation, and PTCD tube could be removed after upper ab-domen CT indicated no obstruction of biliary tract and no residual stone in bile duct. Results All 12 hepatolith patients were treated successfully by cholangiopancreatoscopic Holmium laser lithotripsy in percutaneous tran-shepatic path. The operation duration was 1.0~3.5 h (average 2.5 h). Of the 12 cases, 5 cases were treated with lithotripsy once, 6 cases were treated with lithotripsy twice, and only 1 case was treated with thrice. There was 1 case with fever during operation. The displacement of PTCD was seen in 1 case. Conclusion Cholangiopancre-atoscopic Holmium laser lithotripsy via percutaneous transhepatic path is a minimally invasive, safe and effective treatment for hepatolith.