胆道镜注水加压与传统胆道镜注水防治胆管残余结石临床对比研究  

Clinical comparative study on the prevention and treatment of residual bile duct stones by the method of water injection and pressurization in choledochoscope and traditional choledochoscope water injection

作　　者：吴先麟[1] 张光全[1] 谢亮[1] 姚波[1] 郑柳[1] 廖忠[1] 赵元勋[1] 张文书[1] 蒲成容[1] Wu Xianlin;Zhang Guangquan;Xie Liang;Yao Bo;Zheng Liu;Liao Zhong;Zhao Yuanxun;Zhang Wenshu;Pu Chengrong(Hepatobiliary Surgery,the Sixth People's Hospital of Chengdu City,Sichuan Chengdu 610051)

机构地区：[1]成都市第六人民医院肝胆外科,四川成都610051

出　　处：《中国社区医师》2020年第34期36-37,共2页Chinese Community Doctors

摘　　要：目的:探讨胆道镜注水加压与传统胆道镜注水防治胆管残余结石的疗效。方法:选取2016年1月-2019年12月择期和急诊行胆道探查的患者938例,随机分为胆道镜注水加压组和传统胆道镜注水组,各469例。传统胆道镜注水组为胆道镜注水接入的莫非氏滴管保持快滴不成线的普通状态,巡回护士不进行挤压,取出结石。胆道镜注水加压组为快速的液体注入胆道形成压力,取出结石。结果:手术中胆道镜注水加压组冲开胆总管下段Oddi括约肌见到Vater壶腹有哑铃状结构17例,其中有结石11例,均用网篮取出结石。术后第2天出现上腹痛3例(0.64%),1周后彩超和MRCP证实胆总管内残余结石,及时用EST取出残石。而传统胆道镜注水组胆道镜下见到胆管下端无结石者,术后发生胆管残余结石9例(1.92%),仍用EST顺利处理残石。两组均无其他严重并发症,胆道镜注水加压组比传统胆道镜注水组术后发生残余结石少3倍,差异有统计学意义(P<0.05)。结论:胆总管手术中采用胆道镜注水加压方法防治胆管末段残余结石技术,即简单实用,又能有效进一步降低胆道残余结石发生率。Objective:To investigate the prevention and treatment of residual stones in the end of bile duct.Methods:From January 2016 to December 2019,938 patients undergoing selective and emergency bile duct exploration were selected,and randomly divided into choledochoscope water injection pressure group and conventional flow choledochoscope water injection group with 469 cases in each group.In the conventional flow choledochoscope water injection group,the Murphy's dropper connected by water injection under choledochoscope kept the normal state of fast dripping and no line,itinerant nurses don't squeeze,the stones were removed,and in the choledochoscope water injection pressure group,rapid fluid injection into the bile duct created pressure,he stones were removed.Results:During the operation,the sphincter of Oddi in the lower segment of common bile duct was opened by pressurized water injection under choledochoscope,we found 17 cases of dumbbell shaped structure in ampulla,there were 11 cases of stones,all the stones were removed by basket.3 cases(0.64%)had upper abdominal pain on the second day after operation,one week later,color Doppler ultrasound and MRCP confirmed the presence of residual stones in the common bile duct,the residual stones were removed with therapeutic ERCP.Conclusion:In the operation of common bile duct,choledochoscopic pressurized water injection in the prevention and treatment of residual stones in distal bile duct is a simple and practical technique,which can effectively reduce the incidence of residual bile duct stones.

关 键 词：胆道镜 加压注水 防治 胆管残余结石 

分 类 号：R657.4[医药卫生—外科学]