纤维胆道镜下等离子体冲击波碎石联合逆冲洗治疗难取性胆道残留结石  

Fiber Choledochoscopic Plasma Shock Wave Lithotripsy with Inverse Flush for Difficult Bile Duct Residual Stones

作　　者：朱兴[1] 石刚[1] 孙巍[1] 

机构地区：[1]沈阳市第四人民医院肝胆外科,沈阳110031

出　　处：《中国微创外科杂志》2015年第2期170-172,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：本文报道2009年3月~2014年3月我科经T管窦道纤维胆道镜下用等离子体冲击波碎石与逆冲洗联合治疗难取性胆管残留结石107例,98例完全取净,9例未取净。术中胆道出血5例,喷洒去甲肾上腺素后血止;心律失常4例,剑突下及上腹部胀痛、痉挛痛13例,腹胀、腹泻11例,经对症处理后均好转;术后胆道感染7例,经抗感染,通畅引流治愈。1例失访,106例术后随访6个月,复查超声、CT,101例无结石,5例肝内胆管残留结石未能完全取净。我们认为纤维胆道镜下等离子体冲击波碎石与逆冲洗结合是一种微创、安全、有效的治疗难取性胆道残留结石的方法。The article reported 107 cases of bile duct residual stones treated by plasma shock wave lithotripsy with inverse flush under fiber choledochoscope via T-tube fistula. Of the 107 patients,stones were completely removed in 98 patients,and residual stones remained in 9. Intraoperative biliary hemorrhage occurred in 5 cases,which were stopped after spraying the norepinephrine.There were 4 cases of arhythmia,13 cases of subcostal or upper abdominal pain,and 11 cases of abdominal distention and diarrhea,all of which were cured by symptomatic treatment. Postoperative biliary infection occurred in 7 cases,which were cured by anti-infection and biliary drainage. Except for 1 patient of lost of follow-up,106 patients were followed for 6 months. Ultrasound and CT examinations showed free of calculus in 101 cases,and intrahepatic bile duct residual stones in 5 cases. We deem that plasma shock wave lithotripsy combined with reverse flushing under fiber choledochoscope is a minimally invasive,safe,and effective treatment for difficult biliary residual stones.

关 键 词：纤维胆道镜 胆管结石 等离子体冲击波碎石 

分 类 号：R657.4[医药卫生—外科学]