老年人胆总管结石的内镜治疗  

Choledocholithiasis of Old Patients with Endoscopic Therapy

作　　者：丰义宽[1] 李国庆[1] 田强[1] 张玉英[1] 孙善明[1] 荆巧玲[1] 

机构地区：[1]潍坊医学院附属潍坊市人民医院,山东潍坊261041

出　　处：《潍坊医学院学报》2004年第5期347-348,共2页Acta Academiae Medicinae Weifang

摘　　要：目的　探讨在十二指肠镜下经十二指肠乳头括约肌切开胆总管取石术对老年人胆总管结石的治疗作用。方法　采用电子十二指肠镜行选择性胆管造影 ,明确诊断 ;继之利用高频电刀切开十二指肠乳头括约肌 ,<10mm结石由取石网篮直接取出 ,>10mm结石由碎石篮碎石后再取出。对多次插管导致乳头水肿、胆总管下段狭窄、泥沙样结石、碎石术后难以确定结石是否取净、有胆系感染者在X线下置鼻胆管引流。结果　 6 1例ERCP显示胆总管结石 110块 ,合并胆囊结石 6例 ;其中单发结石 2 0例 ,2块以上结石 4 1例。取石网篮直接取石4 0例 ,碎石后取石 2 0例 ,应急碎石 1例 ,放置鼻胆管 8例。结论　内镜下乳头扩约肌切开胆总管取石术具有创伤小、疗效确切、并发症低、恢复快等特点 ,完全可以代替传统的外科手术 。Objective To investigate therapeutic function against choledocholithiasis of old patients by using EST.Methods Endoscopic retrograde cholangiopancreatography(ERCP) technology is accepted to make specific diagnosis;then EST is taken afterwards.Stones retrieval baskets is used directly when facing calculus with diameter smaller than 10mm.As to the calculus with diameter larger than 10mm,which will be cut it into pieces by stones retrieval baskets and then taken out.Sparry calculus or small calculus after lithotrity are taken with sacculus.Nasobiliary drainage under X-ray radiation is accepted when meeting such condition as cannulation papillaedema after intubation,underside choledochus stenosis,multiple calculus,unknown calculus remaining after lithotrity,cholangitis before operation or billary pancreatitis.Results Sixty one ERCP samples indicate 110 choledochus calculus,6 of which incorporcorate with bilestones.Among these 61 samples, there are 20 samples with singles calculus, 41 samples with 2 or more than 2 stones.Stones retrieval baskets is taken for 40 cases,lithotrity for 20 cases,urgent lithotrity for 1 case and nasobillary drainage for 8 cases.Conclusion EST owns the characterist of tiny wound,definite therapeutic function,low occurrence of complication and high-speed recceperation.It can absolutely substitute traditional operations and become preferred therapeutic method for choledocholithiasis of old patients.

关 键 词：内窥镜 括约肌切开术 胆总管结石 胰胆管造影术 

分 类 号：R657.42[医药卫生—外科学]