内镜下机械碎石术治疗胆总管大结石  

Endoscopic management of large bile duct stones by mechanical lithotripsy

作　　者：贾国法[1] 王美玲[1] 王秀侠[1] 单红[1] 朱良松[1] 孙振兴[2] 

机构地区：[1]安徽省淮北市人民医院消化内镜中心,235000 [2]上海长海医院消化内科

出　　处：《现代消化及介入诊疗》2004年第2期84-86,共3页Modern Interventional Diagnosis and Treatment in Gastroenterology

摘　　要：目的探讨内镜下机械碎石术治疗胆总管大结石的价值。方法32例经ERC证实胆总管结石直径≥1.5 cm。其中结石直径1.5～1.9 cm 17例,2.0～2.4 cm 9例,≥2.5 cm 6例,单颗结石24例,2颗结石5例,3颗或以上结石3例。先行乳头肌切开,然后使用机械碎石器于胆管内将结石粉碎取出。结果机械碎石成功31例,成功率96.9%,失败1例。1次碎石取净结石28例,2次3例,3次1例。发生并发症4例,发生率12.5%,其中切口渗血和出血2例,急性胰腺炎1例,急性胆管炎1例,症状均较轻微。结论对于直径≥1.5 cm的胆总管大结石,单纯使用普通取石网篮难以取出,机械碎石术可不受结石大小限制, 是理想、有效的碎石取石方法。Objective To investigate the clinical value of endoscopic mechanical lithotripsy in management of large common bile duct stones. Methods Thirty-two patients of choledocholithiasis with stone size beyond 1.5 cm in diameter were confirmed by ERC. Among them,17 patients with the stone diameters ranged from 1.5 cm to 1.9 cm, 9 patients ranged from 2.0 cm to 2.4 cm, 6 patients beyond 2.5 cm. Twenty-four patients had single stone, 5 patients had two stones, 3 patients had three or more stones. Endoscopic sphincterotomy (EST) were performed firstly followed by the removal of stones by mechanical lithotripter. Results Mechanical lithotripsy was successful in 31 patients (96.6%). Twenty-eight patients required one session of lithotripsy, three patients two sessions each, and one patients three sessions. Complications occurred in 4 patients (12.5%), including incision blood effusion and bleeding (2 cases), acute pancreatitis (1 case), acute cholangitis (1 case). However, their symptoms were very gentle. Conclusions Large common bile duct stones with diameter beyond 1.5 cm are quite difficult to be removed by conventional stone basket. Endoscopic mechanical lithotripsy is an ideal and effective method regardless the size of the stone.

关 键 词：机械碎石术 内窥镜 胆总管结石 乳头括约肌切开术 EST 术后并发症 

分 类 号：R657.42[医药卫生—外科学]