经胆道镜治疗胆道难取性残留结石

目的：对碎石结合胆道镜取石治疗胆管难取性结石的有效性和安全性作出初步评估。方法：采用碎石后经胆道镜取石的方法治疗１５０例胆道难取性残留结石。其中活检钳碎石５５例，压电冲击波碎石１７例，液电冲击波碎石３８例，碎石篮碎石４０例。对取石失败者联合应用十二指肠镜括约肌切开或乳头气囊导管扩张术（ＥＳＴ／ＥＰＴ）。结果：活检钳碎石、压电冲击波、民冲击波和取石篮碎石取石成功率分别为９０．９％、９４．１％、９４．

THE MANAGEMENT OF REFRACTORY RETAINED BILIARY STONES BY CHOLEDOCHOSCOPY

Objective: To evaluate the efficacy and safety of lithotripsy combined with choledochoscopy in treating refractory residual stones in biliary tract. Methods: A totel of 150 patients with refractory retained bile duct stones were treated by choledochoscopy after lithotripsy. Forceps, piezoelectric shock wave lithotripsy, eletrohydraulic shock wave lithotripsy and basket lithotriptor were used to manage respectively 55, 17, 38 and 40 cases with difficult retained bile duct stones before choldeochoscopy. In the failed cases, combined endoscopic sphincterotomy or endoscopic papillary balloon dilatation is performed. Results: The successful rates of lithotripsy and stones extraction by forceps, piezoelectric shock wave lithotripsy, eletrohydraulic shock wave lithotripsy and basket lithotriptor were 90.9%, 94.7% and 92.5% respectively. These therapeutic procedures combined with endoscopic sphincterotomy and endoscopic papillary balloon dilatation promoted the rate of stones extraction to 97.3%. There were no serious complications. Conclusions: Before stones extracted by choledochoscopy, lithotripsy by forceps, piezoelectric shock wave lithotripsy, eletrohydraulic shock wave lithotripsy and basket lithotriptor for refractory retained biliary stones are effective, relatively simple and less invasive. Combined endoscopic sphincterotomy or endoscopic papillary balloon dilatation may elevate the success rate.