选择性胆管造影在诊治复杂性肝内胆管结石中的可行性与安全性  

Feasibility and safety of selective cholangiography in the diagnosis and treatment of complex intrahepatic bile duct stones

作　　者：王晖 张若涵 罗恒 WANG Hui;ZHANG Ruohan;LUO Heng(General Surgery Department,the First Affiliated Hospital of Nanyang Medical College,Nanyang 473000;Hepatobiliary Pancreatic Splenic Surgery Department,the First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032;Surgical Operation Room,the First Affiliated Hospital of AirForce Military Medical University,Xi'an 710032,China)

机构地区：[1]南阳医学高等专科学校第一附属医院普外科,河南南阳473000 [2]空军军医大学第一附属医院肝胆胰脾外科,陕西西安710032 [3]空军军医大学第一附属医院外科手术室,陕西西安710032

出　　处：《临床医学研究与实践》2023年第27期9-12,共4页Clinical Research and Practice

基　　金：国家自然科学基金委员会资助项目(No.81702329)。

摘　　要：目的 评估选择性胆管造影在诊治复杂性肝内胆管结石中的可行性和安全性。方法 收集南阳市三所三甲医院2017年7月至2021年7月收治的371例症状性肝内结石患者的临床资料,筛选其中168例复杂性肝内胆管结石患者的临床资料进行回顾性研究。采用选择性插管内镜下逆行胰胆管造影术(ERCP)对所有患者行术中胆道造影,后在电子胆道镜指导下完成液电碎石术(EHL)治疗。记录患者的一般资料、胆管造影结果、手术结果及不良事件。结果 所有患者的手术均成功,手术时间29~76 min,平均(42.50±10.80)min。结石完全清除率为98.21%(165/168)。胆管炎发生率为12.50%(21/168),急性胰腺炎发生率为3.57%(6/168),经保守治疗后症状消除。3例(1.79%)患者由于胆管狭窄致胆管结石清除不完全。结论 在胆道镜引导下选择性胆管造影是一种非常有效和实用的鉴别复杂性肝内胆管结石的方法,能够减少胆管探查次数,有效清除肝内胆管结石。Objective To evaluate the feasibility and safety of selective cholangiography in the diagnosis and treatment of complex intrahepatic bile duct stones.Methods The clinical data of 371 patients with symptomatic intrahepatic stones admitted in three tertiary hospitals in Nanyang from July 2017 to July 2021 were collected,and the clinical data of 168 patients with complex intrahepatic bile duct stones were screened for retrospective study.All patients underwent intraoperative cholangiography by selective intubution endoscopic retrograde cholangiopancreatography(ERCP),and then electrohydraulic lithotripsy(EHL)was performed under the guidance of electronic choledochoscopy.The patients'general data,cholangiography results,surgical results and adverse events were recorded.Results The operation was successful in all patients,and the operation time was 29-76 min,with an average of(42.50±10.80)min.The complete stone clearance rate was 98.21%(165/168).The incidence of cholangitis was 12.50%(21/168),the incidence of acute pancreatitis was 3.57%(6/168),and the symptoms were eliminated after conservative treatment.Three patients(1.79%)showed incomplete removal of bile duct stones due to biliary stricture.Conclusion Choledochoscopy-guided selective cholangiography is a very effective and practical method to identify complex intrahepatic bile duct stones,which can reduce the numbers of bile duct exploration and effectively remove intrahepatic bile duct stones.

关 键 词：复杂性肝内胆管结石 选择性胆管造影 内镜下逆行胰胆管造影术 液电碎石术 

分 类 号：R657.4[医药卫生—外科学]