胆道镜治疗术后肝内胆管结石并狭窄13年经验总结：附697例报告

目的:总结胆道镜治疗术后肝内胆管结石并狭窄的经验,提高肝内胆管结石并狭窄的治疗效果。方法:回顾2000年1月—2012年12月应用胆道镜经T管窦道治疗术后肝内胆管结石并狭窄的697例患者临床资料,分析技术要点,评价疗效。结果:672例患者取净结石,结石取净率96.4%。胆道镜共发现1 306支肝内胆管狭窄,其中1 297支狭窄得到解除,狭窄解除率99.3%。狭窄解除、结石取净后患者胆管壁恢复光滑。9例患者出现严重并发症,均经治疗后痊愈。结论:规范的胆道镜治疗能有效解除术后肝内胆管狭窄,取净结石;肝内胆管狭窄的发现及处理是胆道镜治疗的优势,应根据不同狭窄类型分别对待;萎缩肝段切除和术中取石在肝内胆管结石治疗中仍具有重要作用。

Thirteen-year experience in choledochoscopic treatment of postoperative intrahepatic stones with biliary strictures: a report of 697 cases

Objective: To summarize the experience in choledochoscopic treatment of postoperative intrahepatic duct stones and strictures, so as to improve the therapeutic efficacy of this condition. Methods: The clinical records of 697 patients with postoperative intrahepatic duct stones and strictures undergoing choledochoscopic treatment via T-tube sinus tract from January 2000 to December 2012 were reviewed and, the technical essentials were analyzed and therapeutic efficacy was evaluated. Results: The stones were completely removed in 672 patients and rate of complete stone removal was 96.4%. One thousand three hundred and six intrahepatic duct strictures were detected by choledochoscopy, 1 297 of which were dilated, and the stricture-resolution rate was rate was 99.3%. The epithelial cells of the bile duct recovered in the patients after biliary stricture dilation and stone removal. Nine patients developed severe complications that were all resolved by appropriate treatments. Conclusion: The standardized choledochoscopic treatment can effectively resolve the postoperative biliary strictures and remove the intrahepatic stones; detection and management of the intrahepatic strictures is the major advantage of choledochoscopic technique, but they should be treated specifically according to the stricture types. Resection of atrophic hepatic segment and intraoperative stone removal are still the important treatment methods for intrahepatic duct stones.