摘要
目的评价对ERCP取石困难患者行经口直接胆道镜治疗的疗效及安全性。方法回顾性收集2012年4月至2014年8月13例常规ERCP取石困难行经口直接胆道镜治疗患者的临床资料，总结内镜治疗完成情况、不良反应及并发症发生情况。结果12例成功进镜至肝门区以上胆管，液电碎石过程顺利；1例虽进镜至胆总管下段结石处，但碎石取石失败。7例直接用超细胃镜取石网篮取净，5例因碎石较多改由十二指肠镜取石。9例当次完成取石；3例碎石过多当次未能取净，置入胆道塑料支架1周后再次由十二指肠镜取除。术中1例出现呕吐导致血氧饱和度暂时性下降，及时予口咽部吸引并将超细胃镜退至胃吸引后血氧饱和度回升，未影响继续进镜胆道处理结石，术后未发现吸入性肺炎。2例出现高淀粉酶血症，1例出现胆道感染，予相应处理后均得到控制。结论应用经口直接胆道镜治疗十二指肠镜难以处理的胆总管结石是有效和安全的，为ERCP困难结石的治疗提供了新的方法。
Objective To evaluate the efficacy and safety of peroral direct cholangioscopy（PDCS） in the treatment of refractory common bile duct stones after retrograde cholangiopanereatography （ERCP）. Methods Data of 13 patients who underwent peroral direct cholangioscopy for refractory common bile duct stones after retrograde cholangiopanereatography at our institution from April 2012 to August 2014 were retrospectively analyzed. Completion rate, side-effects and complications were summarized. Results Peroral direct cholangioscopy was successfully performed with electrohydraulic lithotripsy and stones were removed in 12 of the 13 patients. Lithotripsy and stone removal failed in one patient, though the ultraslim endoscope accessed distal common bile duct near the stone. Stones were removed directly with extraction basket under PDCS in 7 patients, and duodenoscopy was performed in 5 patients due to too many stone fragments. Stone removal was successfully completed at one time in 9 cases. Stones removal failed in 3 cases at one time because of too many stone fragments, but was successful with duodenoscopy a week later after a temporary biliary tract stenting. Andoxygen saturation decreased in one patient due to vomit during the operation. Sputum in oropharyngeal area was immediately sucked out and the gastric juice at the bottom of the stomach was also sucked by endoscopy. Oxygen saturation returned to normal levels and the subsequent operation was not affected. No aspiration pneumonia occurred after the operation. Hyperamylasemia occurred in two patients, and postoperative biliary tract infection occurred in one, but the situation was controlled after appropriate treatment. Conclusion PDOS using an ultraslim endoscopy is an effective and feasible endoscopic procedurefor the refractory common bile duct stones. This study provides a new method for the treatment of refractory common bile duct stones.
出处
《中华消化内镜杂志》
北大核心
2015年第1期24-28,共5页
Chinese Journal of Digestive Endoscopy
基金
深圳市知识创新计划基础研究项目（JCYJ20140408153331817）
关键词
胆总管结石
直接胆道镜
超细胃镜
胰胆管造影术
内窥镜逆行
Choledocholithiasis
Direct cholangioscopy
Ultraslim endoscopy
Cholangiopancreatography, endoscopic retrograde
