胆道镜治疗术后胆道难取性残余结石

目的 探讨X线引导胆道镜经T管隧道超选择胆道造影方法及其对胆道残留结石介入治疗技术的临床价值.方法 在术后保留T管隧道的条件下,在X线机透视下精确引导胆道镜、导丝、导管、取石网篮等对疑难性胆道改变进行超选择性造影,并对胆道术后残留结石及胆道狭窄进行治疗的45患者进行分析.结果 7例胆管粘连性狭窄胆道反复行局部冲洗及扩张治疗后胆道通畅,2例疤痕性胆道狭窄行扩张效果不佳;7例胆总管结石并左右肝Ⅱ或Ⅲ级胆管多发结石1.5 h内顺利取出;6例左右肝胆管狭窄并多发结石1.0 h内顺利取出;6例肝左右Ⅱ或Ⅲ级胆管多发巨大结石使用液电碎石机碎石后取出,耗时2.0 h以上;6例左右肝Ⅱ～Ⅳ级胆管结石1.5 h内顺利取出;6例单纯胆总管结石30 min内顺利取出.3例左右肝胆管狭窄并多发结石因胆道狭窄未能取出;2例左右肝Ⅱ或Ⅲ级胆管结石因T管隧道出血未能取出.结论 X线引导胆道镜治疗术后胆道残余结石的方法具有易行性、科学性,能提高治疗胆道残余结石的工作效率和成功率.

Choledochoscopy in management of postoperative residual bile duct stones

Objective To evaluate the efficacy of X-ray guided choledochoscopy via T tube tunnel and interventional treatment of residual bile duct stones.Methods Cholangiography was performed in patients suspected of residual bile duct stone with choledochoscopy via the remaining T tube tunnel,and data of 45 patients who received endoscopically treatment for the residual bile duct stones and bile duct stricture were analyzed.Results Seven patients' with adhesive bile duct stenosis were resolved by repeat rinse and dilation,but the procedure failed in 2 cases of bile duct stricture caused by scar;seven cases of common bile duct stone combined with gradeHand Ⅲ multiple hepatic cholelith were removed within 1.5 h:six cases of hepatic bile duct narrowing with multiple cholelith were taken out in 1.0 hour;six cases of grade Ⅱ and Ⅲ multiple massive choledocholith were removed with lithotrity for over 2.0 h:six cases of grade Ⅱ-Ⅳ cholelith were eliminated within 1.5 h:six cases of hepatobiliary stone were removed successfully in 30 min.Stones in 3 cases of multiple stones with intrahepatie bile duct stenosis were not taken out due to bile duct stricture;stones in 2 cases of gradeⅡand Ⅲ multiple choledocholith were not removed for T tube tunnel bleeding.Conclusion X-ray guided choledochoscopy is convenient and effective to remove residue cholelith.