胆总管巨大结石胆道塑料内支架“搅动溶石”作用临床研究  

Litholytic effect of stirring by plastic stent inside biliary tract in large common bile duct stone

作　　者：范震[1] 张啸[1] 张筱凤[1] 吕文[1] 黄平[1] 王辉[1] 

机构地区：[1]杭州市第一人民医院消化科,310006

出　　处：《中华肝胆外科杂志》2010年第1期23-25,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的评价胆道塑料内支架置主入胆总管巨大结石的搅动溶石作用。方法常规方法行ERCP，对45例胆总管巨大结石病人（8例结石伴下端胆管狭窄、5例结石伴乳头过小），在导丝引导下放置8．5Fr胆道塑料内支架治疗。结果3个月后第2次ERCP检查时发现，10例结石消失；22例结石直径变小1／2以上或成碎片状经网篮或气囊扩张顺利取出；13例结石无明显变化，行更换塑料内支架治疗并每月腹部B型超声随访，一旦发现结石明显变小，即再次行ERCP＋取石。经平均2．4次内镜下联合治疗，95．6％（43／45）病人结石取净。期间未发生与ERCP或放置胆道塑料内支架相关的严重并发症。结论放置胆道塑料内支架是治疗胆总管巨大结石简便、有效方法，尤其适用于高危老年胆总管结石病人。Objective To investigate the litholytic effect of stirring by plastic stent inside biliary tract in large common bile duct （CBD） stone. Methods Forty-five patients with large CBD stones were included in this study （8 with the distal bile duct stricture and 5 with too-small Vaterrs papilla）. Plastic stent of 8.5Fr was inserted into the CBD under the guidance of guide wire in all the 45 pa- tients. Results In 10 of the 45 patients, ERCP showed that there was no stone in CBD 3 months later after stent placement. In 22 cases, repeated ERCP revealed that the stone had become smaller to the extent of more than a half or became stone fragments that were easily extracted by baskets or balloon dilation. Thirteen patients continued to have large stone at the second time ERCP treatment, and a new stent was replaced and follow-up performed by B mode ultrasonography of abdominal region per month. Further endoscopic treatment was performed immediately when the stone became small enough. The percentage of 95.6% （43/45） of large CBD stone were eventually cleared after endoscopic treatment for an average of 2.4 times. There were no severe complications related to ERCP or stent placement. Conclusion Placement of plastic biliary stent is a convenient and effective measure for the treatment of large CBD stones. It is especially appropriate for aged patients of CBD stone of high risk.

关 键 词：胆结石 塑料内支架 溶石作用 

分 类 号：R657.4[医药卫生—外科学]