纤维胆道镜的应用与肝胆管结石系列治疗的临床研究

目的：对纤维胆道镜与肝胆管结石的系列治疗进行临床应用性研究。方法：对收治的875例肝胆管结石患者除予以手术治疗外，分别在术前、术中、术后采用纤维胆道镜进行诊治并辅以其他系列治疗措施，如：术前驱蛔治疗、消炎利胆药物使用、经T管胆道冲洗；术中胆道射流震荡冲洗；术后经胆道外引流持续灌注冲洗、射流震荡冲洗、溶石液溶石治疗；中西医结合消炎利胆排石。结果：对带有T管的4例肝胆管广泛结石患者，应用胆道镜等术前系列治疗，手术费时少，术后较早拔除了T管；应用术中胆道镜等系列治疗使手术残石率由78.1％（346/443）降低为24.2％（107/443）；经术后胆道镜等系列治疗，最终残石率为2.4％（21/875）。结论：在肝胆管结石系列治疗中必须应用纤维胆道镜技术方能根本改善其疗效；术前系列治疗可使手术的难度降低，有利于缩短术后恢复时间；术中胆道镜的应用有利于手术的选择，既可有效减少手术残石，又能减少手术创伤；术后胆道镜治疗直接关系到肝胆管结石系列治疗最终残石率的高低，应争取常规应用。

STUDY ON THE ROLE OF CHOLEDOCHOSCOPY AND THE SYSTEMIC THERAPY IN HEPATOLITHIASIS

Objective:To study the role of choledochoscopy and systemic therapy in the treatment of hepatolithiasis.Methods:Eight hundred and seventy-five hepatolithiasis patients admitted all underwent operation, pre-, intra- and post-operative choledochoscopy and other accessory treatments such as 1) expelling roundworm, relieving inflammation and irrigation of the ductal system through T-tube before the operation. 2) flushing in fluid and oscillation during the operation. 3) perfusing and washing continuously, flushing in fluid and concussion via external drainage tube and treatment with stone-dissolving solution. 4) anti-inflammatory ,cholagogue and lithobytic therapy by integrating traditional Chinese with western medicine. Results:Attributed to systemic therapy especially choledochoscopy, 4 hepatolithiasis patients with T tube whose stones were extensive had shorter operation time, and extracted T tube earlier; and the residual stone rate of operation was decreased from 78.1%(346/443) to 24.2%(107/443); and the terminal residual stone rate was 2.4%(21/875). Conclusions:1) It is necessary for the application of choledochoscopy in the systemic therapy of hepatolithiasis. 2) preoperative systemic therapy may decrease the degree of operation difficulty and shorten patient's recovery time. 3) Intraoperative choledochoscopy is benefit for the choose of the method of operation which can reduce not only the residual stone rate,but also the operative trauma. 4) Postoperatite choledochoscopy should be applicated routinely because it is directly related to the terminal rate of residual stone after systemic therapy of hepatolithiasis.