介入超声联合纤维胆道镜治疗肝胆管结石合并急性梗阻性胆管炎

目的：探讨改良超声引导经皮经肝胆管穿刺置管联合纤维胆道镜治疗肝胆管结石合并急性梗阻性胆管炎患的效果。 方法：回顾性分析2013年6月―2014年6月接受改良超声引导经皮经肝胆管穿刺置管联合纤维胆道镜治疗肝胆管结石合并急性梗阻性胆管炎的10例患者的临床资料。 结果：10例患者均穿刺置管成功，置管后2~3 h疼痛症状缓解，24~48 h体温恢复正常，疼痛、寒战症状消失。带管时间为40 d至2个月，平均时间为50 d。置管6~8周后，10例患者成功行经窦道胆道镜取石及狭窄胆管扩张，结石取净率100%。1例患者在穿刺置管10 min后，引流管持续引流出暗红色血性胆汁，向腔内注入立止血夹闭引流管后出血停止。10例患者均未出现漏胆、损伤周围脏器等严重并发症。 结论：改良超声引导经皮经肝胆管穿刺置管联合纤维胆道镜是治疗肝胆管结石合并急性梗阻性胆管炎可靠、有效的方法，值得推广应用。

Ultrasound-guided intervention and cholangioscopic lithotomy for hepatolithiasis with acute obstructive cholangitis

Objective: To evaluate the clinical efficacy of modified ultrasound-guided percutaneous transhepatic catheterization plus cholangioscopic lithotomy in treatment of hepatolithiasis complicated with acute obstructive cholangitis. Methods: The clinical data of 10 patients with hepatolithiasis and acute obstructive cholangitis undergoing ultrasound-directed percutaneous transhepatic catheterization and cholangioscopic lithotomy from June 2013 to June 2013 were retrospectively analyzed. Results: In the 10 patients, ultrasound-guided puncture and catheterization was successfully performed; the pain was relieved 2-3 h after tube placement, while temperature returned to normal level and symptoms of pain and chills disappeared 24-48 h after tube placement. Tube retention time ranged from 40 d to 2 months with an average of 50 d. The 10 patients successfully underwent cholangioscopic stone removal and dilation of bile duct stricture via sinus tract after 6- to 8-week tube placement, and the stone-free rate was 100%. Dark red-colored bloody bile was continuously drained from the drainage tube in one patient 10 min after the puncture and catheterization, which was controlled by intraluminal injection of reptilase and catheter occlusion. No serious complications such as bile leakage or surrounding organ injury occurred in any of the 10 patients. Conclusion: Modified ultrasound-guided percutaneous transhepatic catheterization plus cholangioscopic lithotomy is reliable and effective method for hepatolithiasis with acute obstructive cholangitis, and is recommended to be used.