术中胆道镜联合液电碎石治疗难治性肝内胆管结石的评价  

The evaluation of intraoperative choledochoscopy and electrohydraulic lithotripsy for the treatment of refractory intrahepatic bile duct stones

作　　者：李强[1] 陶亮[1] 吴星宇[1] 蒋智明[1] 邱君斓[1] 牟凌骏[2] 孙喜太[1] 周建新[1] 

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,南京210008 [2]西澳大利亚大学外科系查尔斯盖尔德纳医院

出　　处：《中华消化内镜杂志》2014年第11期638-640,共3页Chinese Journal of Digestive Endoscopy

摘　　要：目的探讨术中胆道镜联合液电碎石治疗难治性肝内胆管结石的治疗策略和临床价值。方法11例难治性肝内胆管结石患者，术中经直视及胆道镜下对患者肝实质、肝内胆管及结石状况进行探查、评估。对拟保留肝叶内的胆管结石采用胆道镜下液电碎石、取石，一次无法取净的患者，二期经窦道胆道镜下液电碎石、取石。结果所有11例患者经术中或二期碎石，均取净结石，治疗成功率100％。手术顺利，术后无手术并发症。本组随访10例，失访1例，随访时间1～3年。3例停用熊去氧胆酸片1～2年后复发肝内胆管小结石，其余7例患者随访期间未见复发。结论术中胆道镜联合液电碎石在有效保证难治性肝内胆管结石治疗成功的同时，最大程度的保护了肝组织，降低了治疗难度及手术风险，减少了术后并发症的发生，提高了患者的生存质量。Objective To explore the therapeutic strategy and clinical value of intraoperative chole- dochoscopy and eleetrohydraulic lithotripsy for refractory intrahepatic bile duct stones. Methods Liver parenehyma, intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 11 cases of refractory intrahepatic bile duct stones. Electrohydraulic lithotripsy and lithotomy were performed to remove the stones and protect the liver parenchyma. If the stones could not be removed once, a secondary lithotripsy and lithotomy was performed through the fistula tract. Results All re- fractory calculi were crushed after one or two procedures and the clearance rate were 100%. No complica- tions occurred. Ten patients were followed up from 1 to 3 years except one. Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholie acid capsules in 1 to 2 years. Seven others showed no stone recurrence within follow-up time. Conclusion Intraoperative choledochoscopy and electro- hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma. The life quality of patients can be improved with low surgical risk and postoperative complications.

关 键 词：胆结石 肝内 胆道疾病 液电碎石 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]