胆系结石液电碎石研究

目的：大胆石和嵌顿性胆石仍然是胆道镜取石的一道难题。该文旨在评估胆道镜直视下液电碎石治疗胆道镜取石困难的胆道结石的临床价值，以及探讨其适应证。方法：应用纤维胆道镜在直视下连续注液的环境中，对１００例（胆道术后残留结石９８例，ＰＴＣＳ２例）胆道镜取石困难的胆管结石病人３进行液电碎石治疗。结果：碎石治疗１３８次，破碎胆石２７５个（胆石位于总胆管３９个，右肝胆管及分支１６５个，左肝胆管及分支１８１个）。

RESEARCH OF CHOLEDOCHOSCOPE ELECTROHYDRAULIC LITHOTHRYPTY

Objective: Large or embedded stones in the bile duct could not be removed by choledochoscopic basket yet. The aim of the present study was to evaluate the clinical value and indication of choledochoscopic electrohydraulic lithotrypty (EHL) for the stones difficult removed by choledochoscopy. Methods: EHL with continuous irrigating sterile saline water under direct vision was used to treat 100 patients (98 patients in retained bile duct calculus, and 2 patients in PTCS) with duct stones which were difficult to eliminate by choledochoscopy. Results: 138 times was used in 100 patients. 375 stones was successful fragmentized, including common bile duct stones 39, left hepatobiliary duct stones 181 and right hepatobiliary duct stones 165. The successful rate in fragmentizing stones was 100%. The rate in completely eliminating the stones was 88% (88 patients), and the improvement rate was 12% (12 patients). The biliary ducts were wounded mildly in 8 patients. There was slight pain in the patients with constrictive intrahepatic duct and common bile duct embedded stones. There were no severe complications, such as severe duct and duct perforation and no death patient. Conclusions: The results showed that EHL was effective and safe. It could cut operative time to remove stones and reduce the deterioration of basket. Most of all, completely eliminating rate was improved. All the large and embedded stones visible in choledochosopy would be indicated by EHL.