直接经口胆道镜对ERCP术后结石残留的诊治价值

目的 探讨直接经口胆道镜（DPOC）作为ERCP术后结石残留补充诊治手段的可行性及安全性。方法 回顾性分析2016年1月至2018年1月在厦门大学附属第一医院行ERCP取石后，补充DPOC治疗的肝外胆管结石高发残留患者资料，观察DPOC成功率、到达位置、结石清除率、操作时间、并发症等。结果 共纳入20例患者，19例DPOC进镜成功，其中5例到达胆总管，7例到达到肝门部，3例到达左右肝管，4例达到2级胆管；平均进镜时间11.7 min。发现胆管残留结石9例，其中7例行DPOC取石，成功5例、失败2例，另有2例患者直接再行ERCP取石。术后出现胰腺炎、出血各1例，胆管炎2例，经保守治疗后均好转。结论 DPOC作为ERCP术后残留结石的一种补充诊治手段可行有效，结石清除率高。

Peroral cholangioscopy for management of residual stones after ERCP

Objective: To investigate the feasibility and safety of direct choledochoscopy in the diagnosis and treatment of residual stones after ERCP. Methods: 20 cases of extrahepatic bile duct stones treated with ERCP were selected from January 2016 to January 2018 in the first affiliated hospital of xiamen university, followed by routine ERCP and DPOC treatment. The success rate of DPOC, arrival location, positive rate, operation time, complications were observed.Results: DPOC were successfully inserted into the common bile duct in 19 cases of 20 patients ,and failed in 1 case.The residual stones were found in 9 cases and no residual stones were found in 10 cases. 5 cases reached the common bile duct,7 cases reached the hepatic portal,,3 cases reached the right and left hepatic duct,and 4 cases reached the level 2 bile duct.The average operating time was 11.7min.Complications: postoperative pancreatitis and hemorrhage occurred in 1 case, and cholangitis in 2 cases. Conclusion: The diagnosis and treatment of residual stones after ERCP by DPOC is feasible and reliable, and the stone clearance rate is high to avoid stone residue.