摘要
[目的]探讨经口直接胆道内镜对困难结石激光碎石的有效性和安全性.[方法]对经内镜逆行胰胆管造影(ERCP)并网篮取石或机械碎石篮碎石失败的21例胆总管困难结石患者进行乳头开口小切开联合15 mm大球囊扩张后,插入经口直接胆道内镜至胆总管,沿内镜活检孔插入双频双脉冲(Nd:YAG)激光探头至结石部位直视下激光碎石,研究其插入成功率、并发症发生率、碎石成功率.[结果]21例中17例(80.95%)达到肝门部并发现结石,其中直接插入5例(23.81%),导丝辅助者9例(42.86%),外套管辅助3例(14.29%);失败4例.15例碎石成功(71.43%),其中6例胆道镜清理结石、9例更换十二指肠镜清理.失败4例(19.05%)转外科开腹手术.4例胆道感染,无严重并发症如出血,穿孔,胰腺炎等,也无手术相关死亡.[结论]经口直接胆道内镜介导的困难结石激光碎石是安全有效的,但内镜插入技术有一定困难,需进一步研究.
[Objective]To explore the effectiveness and safety of the direct biliary endoscopy in difficuit stone lithotripsy.[Methods]The 21 patients who had lost chisel by means of ERCP and net basket or mechanical gravel were named choledocholithiasis cases.The patients were treated with small incision of the nipple and the expansion of 15 mm diameter balloon,insert person ultra fine endoscope(The out diameter of 5,6 dishes can be inserted through the nasal cavity into the digestive tract for diagnosis and treatment.It was also named transnasal)to bravery manager.Along the endoscopic biopsy channel,we insert double-frequency(Nd:YAG)laser probe-stone parts under the direct laser lithotripsy.Its insertion success rate and the incidence of gravel success rate were investigated.[Results]The 17 of 21 cases(80.95%)were reached the hepatic portal and found stones,among which 5 cases(23.81%)were inserted directly and 9 cases(42.86%)were assisted by guide wire,3 cases(14.29%)were assisted by outer casing and 4 cases failed.15 cases were sussessful(71.43%),6 cases of biliary tract were removed and 9 cases were replaced with duodenoscope.4 cases(19.05%)failed and accepted surgery.There were 4 cases of biliary tract infection,no serious complications such as bleeding,perforation,pancreatitis as well as surgical related death.[Conclusion]It is safe and effective for the difficult calculus lithotripsy to be mediated by oral direct biliary endoscopy.But the endoscopic insertion technology has certain difficulties.Further study is needed.
作者
周生勇
肖鹏浩
李小京
刘志琴
董新锋
ZHOU Sheng-yong;XIAO Peng hao;LI Xiao-jing;LIU Zhi-qin;DONG Xin-feng(Department of Gastroenterology,the First People's Hospital of Jiayuguan,735100 Jiayuguan,China)
出处
《临床消化病杂志》
2020年第3期151-154,共4页
Chinese Journal of Clinical Gastroenterology
关键词
胆总管结石
胆道镜
经口直接胆道内镜
激光碎石
choledocholithiasis
choledochoscope
viaoral direct biliary endoscopy
laser lithotripsy
