胆道镜下液电碎石治疗复杂胆道术后残余结石312例疗效分析

目的:探讨胆道镜下液电碎石(EHL)治疗复杂手术后胆道残石的疗效和安全性.方法:对312例复杂胆道术后残余结石的病人行纤维胆道镜下液电碎石治疗并进行分析.其中有多次胆道手术史者(2-6次)192例,胆管结石合并胆汁性肝硬化39例,结石巨大嵌顿40例,胆管狭窄41例.结果:312例复杂胆道术后残余结石患者经纤维胆道镜下液电碎石治疗,取石成功307例,成功率98.4%;取石失败仅5例(1.6%),其中胆管管状狭窄2例.窦道闭合3例.随访时间平均40.5月(6-75月),取石成功病人中293例(95.4%)长期疗效优良,而5例取石失败者均有明显不适症状.无胆道穿孔等严重并发症发生.结论:纤维胆道镜下液电碎石治疗复杂胆道术后残余结石效果好,安全易行,远期疗效确切,大大减少手术对患者带来的痛苦,是此类病人很好的治疗方法.

A STUDY ON THERAPY OF COMPLEX RESIDUAL CONCRETION WITH CHOLEDOCHOSCOPE COMBINED WITH CHOLEDOCHOSCOPE COMBINED WITH ELECTROHYDRAULIC LITHOTRIPSY UPON COMPLETING OPERATION OF BILAIARY TRACT IN 312 PATIENTS

OBJECTIVE:To evaluate the efficacy and safety of choledochoscopic technique combined with electrohydraulic lithotripsy(EHL) for postoperative complex residual biliary stones.METHOD:Fibre choledochoscopic technique combined with EHL were performed on 312 patients with complex residual concretion and the results were analyzed.Among them,192 cases had been conducted more than two bile duct sugeries.39 cases complicated with biliary hepatocirrhosis.40 cases were found big incarcerated stones and 41 stricture of bile duct.RESULTS: Residual biliary stones were extracted successfully in 307(98.4%) patients.Only 5 cases(1.6%) were failed,among them 2 cases were because of biliary stricture and 3 were sinus closure.Follow-ups ranged from 6 to 75 months(average: 40.5 months).An excellent or good long term result was obtained in 293(95.4%) patients,whose retained stones were extracted successfully.The 5 patients with unsuccessful procedure were found obvious symptom.No serious complications occurred such as biliary perforation.CONCLUSION:Choledochoscopic technique with EHL assisted extrating retained stones is a highly effective and safe procedure in the treatment of patients with complex residual biliary stones after surgery.The forward curative effect is good and can greatly reduce the suffering of patients from sugery.The treatment can be the first choice of the patients.