难取性胆管结石内镜综合治疗的探讨

目的探讨肝内外胆管多发性结石、巨大结石、壶腹部嵌顿性结石、小乳头及乳头旁憩室切开禁忌者、T管引流术后残余结石ERCP困难者等难取性胆管结石内镜治疗。方法分别采用术中、术后胆道镜、EST后机械碎石、胆道子母镜、鼻胆／胆肠引流等方法。结果 149例难取性胆管结石中。术中胆道镜取净率95％(19／20),术后经T管胆道镜取净率(35／40)87．5％,机械碎石率94．7％,(72／76),肝外胆管结石取净率94．6％(122／129)。结论应用内镜下综合治疗难取性胆管结石大大提高了结石取净率、减少了残石率。达到去除病灶、通畅引流,值得推广。

The treatment of the intractable bile duct stones: analysis of 149 cases

Objective To investigate the treatment of intractable bile duct stones. Methods Of the total 149 cases of biliary stones, some are multiple bile duct stones,large stones,stones obstructed in the duodenal ampulla or residuary stones after T-tube surgery, others are associated with small papilla or papilla with neighoring diverticulum. All the stones were extracted with several endoscopic methods, such as choledochoscopy during or after operation, mechanical lithotripsy after EST(endoscopic sphincterotomy), biliary mother-baby endoscopy, ENBD(endoscopic nasobiliary drainage) or biliary-duodenum internal drainage. Results In general, extrahepatic bile duct stones were effectively removed in 94. 6% cases. In 19 out of 20 cases, stones were completely removed with choledochoscopy during operation; In 35 out of 40 cases stones were fully extracted through T-tube endoscopy, and in 72 of 76 cases stones were thoroughly removed with mechanical lithotripsy after EST. Conclusion The intractable bile duct stones can be effectively managed with combined endoscopic therapy, which is attributed to the high success rate in removing biliary stones and should be popularized in this field.