经皮经肝胆总管结石球囊推石的临床应用价值  

Clinical Value of Pushing Stones by Balloon with Percutaneous and Transhepatic for Choledocholithiasis

作　　者：陈锦州 朱培欣 李建军 王闯胜 肖贾伟 CHEN Jinzhou;ZHU Peixin;LI Jianjun;WANG Chuangsheng;XIAO Jiawei(Intervention Radiology Department,General Hospital Department of Medical Group of Pingdingshan Coal and Shenma Association)

机构地区：[1]平煤神马集团总医院介入放射科

出　　处：《中国医学计算机成像杂志》2022年第2期191-195,共5页Chinese Computed Medical Imaging

摘　　要：目的:探讨经皮经肝穿刺入路,球囊扩张十二指肠乳头Oddi括约肌,继而球囊推送胆总管结石至十二指肠腔的安全性及有效性。方法:回顾性分析21例胆总管结石患者,采用经皮经肝穿刺肝内胆管,应用球囊扩张十二指肠乳头Oddi括约肌,连续扩张3次,每次持续1min;继而用球囊缓慢沿导丝顺胆总管走行向十二指肠腔内推送结石。若结石较大,通过十二指肠乳头困难,可更换更大球囊扩张Oddi括约肌,并再次尝试推送结石,球囊最大直径不超过18mm。若反复尝试后,结石通过十二指肠乳头仍困难,则终止手术。术后置入8F内外引流管于胆总管内,持续内外引流1周,减轻胆道内压。术后常规禁食、抗炎等治疗。1周后复查CT及超声,若证实无结石残留,拔出引流管,并于术后第1、3和6个月复查超声了解有无结石复发。结果:21例患者中18例成功完成手术,成功率85.7%(18/21),失败3例,其中1例结石长径29.0mm,结石过大;1例结石长径11.5mm,形态不规整,有棱角;1例患者脏器功能太差,无法耐受胆道刺激。术后1周,患者发热、黄疸、腹痛等术前症状逐渐消失,术前合并急性胰腺炎及胆囊炎者均治愈。术后并发疼痛8例、少量胆道出血4例、胰腺炎1例,均经药物治疗后缓解。随访期内无结石再发。结论:经皮经肝胆总管结石球囊推石治疗,技术可行,安全有效;对于高龄、合并基础疾病多、心肺功能差、全麻耐受能力差及不愿意外科手术的胆总管结石患者,可考虑选择该手段治疗。Purpose:To study the safety and effectiveness of balloon pushing common bile duct stones into duodenum after balloon dilating Oddi sphincter of duodenal papilla with percutaneous and transhepatic puncture.Methods:Twenty-one patients with choledochal cholelithiasis were undergone percutaneous and transhepatic puncture,the duodenal papillary Oddi sphincter was dilateted with balloon for 3 times,and each time lasted for one minute.Then the the stones were pushed into the duodenum along the guidewire through the common bile duct by the balloon.For large diameter stone,a larger balloon was replaced to dilate the oddi sphincter again.If it was still difficult for the stones passing through the duodenal papilla over and over,the operation was terminated.After operation,the internal and external drainage tube was inserted into the common bile duct for one week,the purpose of which was relieved the pressure of bile duct.Conventional treatment included fasting,anti-inflammatory and other treatments after operation.After one week,CT or ultrasonic were done.If stones were disappear,drainage tube was pulled out.Then 1,3 and 6 months later,ultrasound was done to observe whether there was recurrence of stone.Results:Of the 21 patents,operation of 18 cases were successful,the success rate was 85.7%(18/21).Operation of the other 3 cases were failed,unsuccessful reason for one case was too large of the stone,longest diameter of which was 29.0 mm.For another case,the stone with 11.5 mm in length were irregular in shape and angular.For last case,the patient had poor organ function and could not tolerate tractive stimulation from operation.Symptoms such as fever,jaundice and abdominal pain disappeared gradually one week after operation.Acute pancreatitis and cholecystitis before preoperative occurrence were cured.Postoperative pain occurred in 8 cases,minor haemobilia occurred in 4 cases and pancreatitis occurred in one case,all of which eased by medication.No stones occurred during the follow-up period.Conclusion:With percutaneous a

关 键 词：胆总管结石 经皮十二指肠乳头球囊扩张术 经皮经肝穿刺胆道引流术 介入治疗 

分 类 号：R816.5[医药卫生—放射医学]