胆道镜技术的应用与肝胆管结石手术方式的合理选择  

Application of choledochoscopy and proper choice of operation on patients with hepatolithiasis

作　　者：马利林[1] 徐青[1] 陆丽萍[1] 沈洪薰[1] 陈玉泉[1] 

机构地区：[1]南通医学院附属医院普外科,江苏南通226001

出　　处：《中国普通外科杂志》2000年第2期108-111,共4页China Journal of General Surgery

摘　　要：目的　探讨胆道镜技术在肝胆管结石术式选择中的作用与地位。方法　总结肝胆管结石 6 18例应用胆道镜技术的经验。常规探查取石处理病灶后 ,根据镜检结果 ,选择不同术式 :游离结石予取石网套取 ;肝胆管管形狭窄者争取行肝叶段切除 ;膜状狭窄予以胆道镜扩张 ;胆总管下端不通畅者选择内引流术 ;结石难以取净者必须选用或加作外引流 ;肝门部、左右肝管开口明显狭窄者须予以切开成形。结果　术中经常规器械探查取石 ,残石率为 78 3% (2 6 3/ 336 ) ;经应用胆道镜诊治技术 ,选择术式 ,残石率降低为 2 5 9% (87/336 ) ;经术后胆道镜等系列治疗 ,最终残石率为 2 8% (17/ 6 18)。结论　胆道镜技术有利于正确选择手术方法 ,既能有效地发现并去除病灶 ,又能简化手术 ,值得推广。Objective To evaluate the role of choledochoscopy in selecting operation procedure for hepatolithiasis. Methods Experience in choledochoscopy applied in 618 cases of hepatolithiasis was summerised. After conventional calculi extraction and focal lesion treatment, following steps were taken according to the examination by choledochoscopy: (1) hitch free calculi out with grasping basket; (2) perform hepatolobectomy for tubiform stenoses in hepatic duct; (3) perform dilation with choledochoscopy for membraniform stenoses in hepatic duct; (4) perform inner drainage for impassability in inferior extremity of common bile duct; (5) external drainage must be selected or added if calculi can't be extracted completely; (6) perform hepatocholangioplasty for obvious stenoses in left or right hepatic duct. Results Calculi extraction with conventional appliances had a residual stone rate of 78.3%(263/336); but the rate declined to 25.9%(87/336) after the use of intra operative choledochoscopy and systemic therapy including post operative choledochoscopy; the final residual stone rate was 2.8%(17/618) after postoperative choledochscopic treatment. Conclusions Choledochoscopy benefits the proper choice of operation for hepatolithiasis. It helps not only to discover and get rid of focal lesion effectively but also simplifies the operation.

关 键 词：胆结石 胆管 内窥镜术 外科手术 治疗 

分 类 号：R657.420.5[医药卫生—外科学]