B超引导下十二指肠镜肝外胆管取石方法的探讨  

Investigation of the method of removal of calculus from extrahepatic bile duct through duodenoscope under the guidance of ultrasound B

作　　者：任清华[1] 王丙信[1] 程秀莲[1] 胡森[2] 张维莲[1] 宋萧逸[1] 

机构地区：[1]解放军第251医院消化内科,张家口075000 [2]解放军总医院第304临床部全军烧伤研究所,北京100037

出　　处：《感染．炎症．修复》2005年第3期146-148,2,共4页Infection Inflammation Repair

摘　　要：目的：研究和探讨B超引导内镜肝外胆管取石的方法。方法：对B超引导下十二指肠镜肝外胆管取石患者26例(B超组)和X线引导下肝外胆管取石患者(X线组)38例进行对比分析。结果：B超组的26位患者：术后2h和24h血清淀粉酶分别为179．68±94．45U和214．47±282．59U,其中仅有2例发生高淀粉酶血症(2/26,7．69%)。X线组的38位患者：胰管显影14例(14/38,36．84%),术后2h和24h血清淀粉酶分别为275．68±314．45U和354．47±482．59U,其中高淀粉酶血症9例(9/38,23．68%),注射性胰腺炎2例(2/38,5．26%)。内镜操作员在X线照射下平均工作时间为21．4min,而B超组内镜操作人员和患者可完全不受X线照射。结论：B超引导下十二指肠镜肝外胆管取石内镜操作人员可完全避免电离辐射危害；患者可避免注射性胰腺炎的发生,而且高淀粉酶血症的发生率也明显降低。Objective:To explore method of removing calculus from the extrahepatic bile duct through a duodeno- scope under the guidance of ultrasound B.Methods:Comparision analysis was performed between a group of 26 pa- tients in whom the operation was performed under the guidance of ultrasound B and with a group of 38 patients with X-ray fuidance.Result:Among 38 patients with X-ray guidance,the pancreatic duct was visualized in(14/38, 36.84%),9 patients developed hyperamylasemia(9/38,23.68%),and 2 patients were complicated by injection pancreatitis(2/38,5.26%).The average time for the doctors to work under X-ray was 21.4min.Their mean val- ues of serum amylase at 2h and 24h after operation were(275.68±314.45U)and(354.47±482.59U)respectively. On the other hand,there were only 2 cases with hyperamylasemia in 26 patiens with ultrasound B guidance.Their mean values of serum amylase in 2h and 24h after operation were(179.68±94.45U)and(214.47±282.59U)re- spectively.The doctors and patients could completely avoid X-ray irradiation.Conclusion:The doctors who re- move calculus from the extrahepatic bile duct through duodenoscope under the guidance of ultrasound B can com- pletely avoid the hazard of radiation,the risk of injection pancreatitis can ve minimized,and the incidence of hy- peramylasemia can be decreased.

关 键 词：B超 X线 十二指肠镜 肝外胆管结石 

分 类 号：R65[医药卫生—外科学]