双镜联合治疗肝外胆管结石取石困难的原因分析  

Intraoperative difficulties and countermeasures of treating extrahepatic bile duct stone with double endoscopes

作　　者：赵国刚[1] 李德新[2] 李强[1] 

机构地区：[1]川北医学院附属医院,川北医学院肝胆胰肠研究所 [2]四川省医学科学院,四川省人民医院城东病区,四川南充637000

出　　处：《腹腔镜外科杂志》2012年第12期928-930,共3页Journal of Laparoscopic Surgery

摘　　要：目的:分析双镜联合治疗肝外胆管结石取石困难的原因,并探讨取石技巧。方法:回顾分析2009年5月至2012年5月为639例肝外胆管结石患者行纤维胆道镜取石的临床资料,其中83例取石困难,分析取石困难的原因及对策。结果:取石困难的原因有Trocar因素、结石因素、胆道因素;其中Trocar因素8例,结石因素64例,胆道因素11例。4例术中等离子碎石,2例术中行钬激光碎石,余均应用纤维胆道镜成功取出结石。术后随访,无残留结石。结论:双镜联合治疗肝外胆管结石取石困难的原因各不相同,应根据具体原因采用不同的处理方法。Objective：To analyze the reasons why it is difficult to remove stones in the treatment of extrahepatic bile duct stones with double endoscopes and the corresponding countermeasures. Methods ：The clinical data of 639 patients who underwent lithotomy with biliary tract choledochoscopy for extrahepatic bile duct stone from May 2009 to May 2012 were analyzed retrospectively, of which,83 cases underwent a tough lithotomy surgery, and the reasons and countermeasures were analyzed. Results ：The reasons for the difficulties include ： trocar factor （ 8 cases）, calculus factor （ 64 cases）, biliary factor （ 11 cases）. Of all the patients who underwent a tough surgery,4 patients were converted to intraoperative plasma gravel. 2 patients were resorted to intraoperative holmium laser gravel, the rest were treated with choledochoscope, and all the stones were removed successfully with no residue. Conclusions：The difficulties were caused by different reasons. We should take different methods according to actual situations.

关 键 词：胆道结石 纤维胆道镜检查 手术技巧 

分 类 号：R657.42[医药卫生—外科学]