经十二指肠镜治疗肝内胆管结石283例临床研究  

Using duodenoscope to treat hepatolithiasis:a clinical observation on 283 cases.

作　　者：麻树人[1] 孟威宏[1] 张宁[1] 杨卓[1] 赵云峰[1] 赵志峰[1] 张迎春[1] 潘汝明[1] 韩笑[1] 高峰[1] 宫照洁[1] 杨琳[1] 常莉雅[1] 胡馨予[1] 袁爱娇[1] 孙亚男[1] 金晓龙[1] 

机构地区：[1]沈阳军区总医院内窥镜科全军消化内镜中心,沈阳110016

出　　处：《中国实用内科杂志》2009年第8期735-737,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨经十二指肠镜沿正常生理通道治疗肝内胆管结石的经验。方法收集1996年9月至2009年1月在沈阳军区总医院常规行内镜下逆行胰胆管造影(ERCP)、十二指肠乳头切开(EST)患者283例资料,合并肝外胆管结石先行ERCP取出结石,合并胆管狭窄行柱状气囊扩张术,再行肝管碎石及网篮、球囊取石术,取石困难者行鼻胆引流后注入中药溶石治疗或胆管内支架治疗后择期取石。结果283例肝内胆管结石患者中,101例合并肝外胆管结石均一次取出,肝内胆管结石一次完全取尽215例。余68例中,9例行鼻胆管注入中药溶石治疗1周,再行ERCP取尽结石;59例行肝内胆管内支架置入术,3个月后行ERCP取尽21例,37例结石未取尽,继续留置胆管内支架,无任何不适,建议定期随访。33例合并肝内胆管狭窄经柱状气囊扩张治疗治愈19例,14例行胆管内支架支撑治疗。19例合并肝内胆管脓肿经鼻胆引流治疗脓肿消失。结论经十二指肠镜沿正常生理通道治疗肝内胆管结石安全可靠、疗效满意。Objective To explore the experience on using duodenoscope to treat hepatolithiasis through normal physiological ways. Methods ERCP,EST were used firstly,then removed calculus of the extrahepatic bile duct. Endoscopic papillary balloon dilatation was used if there was stenosis of bile duet. Removed calculus when it had been crushed in the hepatic duct. Injected decoction to dissolve calculus through endoscopic nasobiliary drainage, or inserted the endoscopic retrograde biliary drainage when the calculus was hard to removded. Results 101 cases of calculus in the extra-hepatic bile duct were all removed. 215 cases of hepatolithiasis were cleaned out at first time. 9 cases were cured 1 week after dissolving calculus through endoscopic nasobiliary drainage. 59 cases carried out ERBD, and 21 of them were cured 3 months later,37 patients were still in regular follow-up. 33 cases with stenosis of bile duet were treated by endoscopic papillary balloon dilatation, 19 of them were cured, the others were inserted with the endoscopic retrograde biliary drainage. 19 cases of cholangitic abscess were cured by endoscopic nasobiliary drainage. Conclusion Using duodenoscope to treat hepatolithiasis through normal physiological ways is safe and effectic.

关 键 词：胰胆管造影 十二指肠镜 肝内胆管结石 

分 类 号：R5[医药卫生—内科学]