纤维胆道镜术中诊治胆道结石常见失败原因分析

目的探讨纤维胆道镜术中诊断和治疗胆道结石碰到的问题和常见的失败原因。方法对714例以术中胆道镜治疗胆道结石的临床病例进行分析和总结。结果其中,132例术后有胆道结石残留,残余结石率为18.5%。术中已知结石残余54例,术后经T管造影和术后胆道镜证实有结石残余78例,78例中包括肝内胆管结石伴胆管开口狭窄29例、肝内胆管结石伴胆管变异37例、胆总管下段节段性狭窄伴结石12例。结论术中胆道镜治疗胆道结石时要注意有无胆道变异和病变胆管开口狭窄或胆总管下端节段性狭窄等情况,术者应按顺序逐支逐段地检视,对胆道应采用连续的窥视方法以尽量避免主观和客观因素引起的术后结石残留。

Causes of failure in choledochoscopic diagnosis and removal of gallstone

Objective To discuss the causes for failure in diagnosis and removal of gallstone using choledochoscope. Method A retrospective analysis was conducted in 714 cases of gallstone treated with choledochoscopic operations. Results Residual stones in the bile duct were found in 132 (18.5%) cases after the operation. In 54 cases the bile duct stones failed to be completely removed even before the closure. By T-tube cholangiography and choledochoscopy after the operation, 78 cases were found to have residual bile duct stones, among them 29 were complicated with intrahepatic bile duct and bile duct opening stenosis, 37 with intrahepatic bile stone and bile duct variation, and 12 with choledochus inferior segment stenosis and stone formation. Conclusion Due attention should be paid during the choledochoscopic operation to bile duct variation, bile duct opening stenosis or choledochus inferior segment stenosis, which should be carefully inspected by segments in succession to minimize the possibility of residual stones.