经胆囊管胆道镜胆总管探查及取石术的临床应用

目的探讨经胆囊管胆道镜胆总管探查及取石术的有效方法和适应证。方法选择疑有胆总管结石及有探查指征的61例患者，在胆囊切除时将胆囊管残端稍为留长，以便于提取牵拉。选用OLYMPUS—P20型胆道镜沿胆囊管轻柔插入，如胆囊管尚不够粗，可先予扩张。胆道镜发现结石后，以取石网篮套取拉出。如结石较大难以通过胆囊管者则常规切开胆总管取石。镜检及取石结束后经胆囊管注入庆大霉素8-16万单位后予胆囊管结扎。结果29例在胆总管下端发现结石，其中24例在胆道镜下予取石网套取除，5例因结石较大常规切开胆总管取除，32例未发现结石。61例患者术后均恢复良好，术后无胆漏、胆道出血发生。B超随访或术后T管造影无结石残留。结论经胆囊管行胆总管探查及取石术是一项较为有效的微创技术，可使部分患者减少创伤，缩短治疗周期，但其主要适用于胆总管继发性小结石同时伴胆囊管增粗者。

Common bile duct exploration and lithotomy through cystic duct under choledochoscope

Objective To investigate the methods and indications of common bile duet exploration and lithotomy through cystic duct under choledoehoscope. Methods Sixty-one patients with suspected common bile duet calculi or other exploration indicator were selected. Cystic duet was retained length enough for facilitating following procedure, OLYMPUS-P20 eholedochoseope was gently inserted into cystic duet （ Cystic duet would be explanted ff it was not big enough in diameters）. Calculus was pulled out when it was found through eholedochoseope. The huge calculus bigger than eystie duet in diameter that made them difficult to pass it would be removed by routine common bile duet exploration procedure. Cystic duet was ligated after injection of 80 000- 160 000 units of gentamiein through it at the end of operation. Results In 29 patients with calculi at the distal of the common bile duet, ealeuli were removed through cystic duet under eholedoehoseope in 24 patients, the calculi in other 5 patients was removed by routine common bile duet exploration procedure, no calculus was found in the remain 32 patients. Sixty-one patients recovered well and quickly after operation. No postoperative bile leakage and biliary tract bleeding occurred after operation in all sixty-one patients. Post-operation ultrasonograph and T tube imaging cheek concerned no retain calculus in common bile ducts. Conclusion Common bile duet exploration and lithotomy through cystic duet under eholedoehoseope is a effective technique with less operation trauma, quickly recover and can decrease in-hospital days in patients with suspected common bile duct calculi. At present, it is mainly applied to secondary small calculi in common bile duct with distention cystic duet.