胆道镜经T管窦道取石网篮嵌顿12例分析

目的探讨胆道镜经T管窦道取石术中取石网篮嵌顿的原因和对策。 方法回顾性分析湖南省人民医院2017年1月至2019年12月胆道术后经T管窦道取石术中取石网篮嵌顿12例患者资料，统计嵌顿部位结石胆管内径比、结石性质、处理方式、处理结局。 结果12例术中取石网篮嵌顿患者术前T管造影片测量结石直径/胆管狭窄口直径均>1.2 cm，嵌顿结石均为胆色素结石。其中3例通过取石网篮往一侧推进后收网成功、3例使用另外胆道镜进行碎石后取出、6例剪断取石网篮后碎石取出。所有患者均取出取石网篮，其中5例胆道出血，均使用去甲肾上腺素盐水冲洗后止血。 结论需重视胆道镜经T管窦道取石网篮嵌顿，术前T管造影结石胆管内径比可以预测嵌顿可能，碎石有利于避免因强行拔出导致出血，保障手术安全。

Choledochoscopy was used to remove stones from the T-tube sinus tract and the basket were incarcerated in 12 cases

Objective To explore the causes and countermeasures of basket incarceration in choledochoscopy through T-tube tract lithotripsy.Methods Retrospective analysis of the data of 12 patients with basket incarceration during biliary tract lithotripsy after bile duct surgery from Jan.2017 to Dec.2019 in Hunan Provincial People′s Hospital.And the internal diameter ratio of stone bile duct at incarcerated site,stone properties,treatment methods and treatment outcomes were calculated.Results The diameter of stones/diameter of bile duct stenosis measured by preoperative T-tube radiography in 12 patients was all greater than 1.2 cm,and the incarcerated stones were all gallbladder pigment stones.Three patients were successfully netted after being pushed to one side by the basket,three patients were removed after using additional choledochoscopy,and the remaining six patients were removed after cutting the basket.The basket were removed from all cases,and 5 cases of biliary bleeding were rinsed with noradrenaline saline and stopped bleeding.Conclusions We need to pay attention to the choledochoscopy through the T-tube sinus tract for basket incarceration,preoperative T-tube angiography stone bile duct diameter ratio can predict the possibility of incarceration,and the lithotripsy is conducive to avoiding forced extraction leading to bleeding,thus ensuring the safety of surgery.