输尿管镜治疗难治性肝内胆管结石临床体会  

Experience of ureteroscopic pneumatic lithotripsy for refractory hepatolithiasis

作　　者：朱云根[1] 王建仁[1] 李跃兵[1] 李建群[1] 

机构地区：[1]江西中医药高等专科学校附属医院外科,江西抚州344000

出　　处：《中国内镜杂志》2012年第5期508-511,共4页China Journal of Endoscopy

摘　　要：目的探讨输尿管镜气压弹道碎石取石技术治疗难治性肝内胆管结石的可行性及临床价值。方法回顾分析48例胆总管结石合并肝内胆管结石患者应用Fr8/9.8硬性输尿管镜及气压弹道碎石,在开放手术的基础上完成肝内胆管结石碎石取石手术。结果 48例患者均顺利完成手术,无胆道出血、胆汁漏等情况发生。其中45例(93.75%)患者肝内、外胆管结石一次性完全清除,3例(6.25%)因腹壁肥胖及结石部位特殊(右肝前叶上段2例、左肝外叶上段1例),硬性输尿管镜较难进入而致肝内胆管出现部分结石残留,术后无肝外胆管残石、胆道出血、胆汁漏等并发症出现,随访6～36个月,无结石复发及腹痛、发热、黄疸等。结论采用输尿管镜气压弹道碎石取石技术处理难治性肝内胆管结石,方法安全可靠,具有创伤小、残石率低、出血少、并发症低等优点,值得推广使用。[Objective] To investigate the clinical value and feasibility of ureteroscopic pneumatic lithotripsy lithotomy in treating intractable hepatolithiasis. [Methods] 48 patients with common bile duct stones and hepatolithiasis which applied Fr8/9.8 rigid ureteroscopy and pneumatic lithotripsy in the open surgery were retrospectively analyzed based on the completion of hepatolithiasis gravel stone surgery. [Results] 48 cases were successfully completed the operation. Without biliary bleeding, bile leakage from happening. 45 cases （93.75%） of patients with intrahepatic and extrahepetatic bile duct stones were removed one-time. 3 cases （6.25%） rigid ureteroscope could not reach due to residual calculus in abdominal obesity and the special position （such as in the upper right hepatic lobe prior or left hepatic lobe or upper）. All the patients had no complications as biliary tract bleeding, bile leakage, jaundice, etc. [Conclusion] To use the technology of ureteroscopic pneumatic lithotripsy deals with intrahepatic bile duct stones in refractory. This method is safe and reliable, with less trauma and the low rate of residual stones, less bleeding and low complications, etc.

关 键 词：输尿管镜 气压弹道碎石 肝内胆管结石 

分 类 号：R657.4[医药卫生—外科学]