术中胆道镜取石失败原因分析及对策探讨.docxVIP

术中胆道镜取石失败原因分析及对策探讨

【摘要】目的分析术中使用胆道镜治疗胆道结石常见的失败原因以及对策。方法对自1997年1月至2006年12月间292例曾经使用胆道镜术中取石的病例进行回顾分析。结果292例患者中，术后有胆道残石39例，残石率为﹪。其中术中明确结石未取净者19例；经术后T管造影及胆道镜明确胆道残石者20例。胆道镜术中取石失败原因是多方面的。39例残石者中包括肝内胆管结石伴胆管变异14例；肝内胆管结石伴胆管开口狭窄11例；肝内胆管大结石嵌顿3例；胆总管下段节段性狭窄伴结石3例。结论术中要细致进行胆道镜检查，要逐叶逐段检查各条胆管，要注意有无胆管变异，要找出狭窄的胆管开口以及胆总管下段有无节段性狭窄等情况，对于大的胆管结石建议行激光或液电碎石。术中B超定位有助于降低术后残石率。

【关键词】胆道镜胆结石治疗

AbstractObjectiveToanalyzecommonreasonsoffailureinremovalofgallstoneswithcholedochoscopeduringoperationandexplorethecountermeasure.MethodsThedateoftwohundredandninty-twopatientsundergonecholedochoscopeinoperationforremovalofgallstonesduringtheperiodofwereanalyzedretrospectively.ResultsOf292patients，residualstonesinthebileductaftertheoperationswerefoundin39patients.Residualstonesratewas%.Gallstonescouldnotbecompletelyremovedduringtheoperationin19patients.ResidualstoneswerefoundinthebileductafteroperationwithT-tubecholangiographyandcholedochoscopeintheother20patients.Thereweremanyfailurereasonsofremovalofgallstonesusingcholedochoscopeduringoperation.Itwasfoundthat39patientswithresidualstones，14complicatedwithstonesinintrahepaticbileductandvariationofbileduct，11complictatedwithstonesinintrahepaticbileductandnarrowdebouchmentsofbileduct，3complicatedwithbigimpactedstonesinintrahepaticbileduct，3complicatedwithstonesattheinferiorsegmentofcholedochusstenosis.ConclusionThebileductofeveryhepaticlobeandsegmentshouldbecarefullycheckedwithcholedochoscopeduringoperationinordernottoomitanystones.Itisimportanttopayattentiontovariationofbileductandnarrowdebouchmentsofbileductandinferiorsegmentofcholedochusstenosis.Laserorelectrohydrauliclithotripsyisadvisableforbiggallstones.ThemethodoflocalizationwithB-ultrasoundishelpfultoreduceresidulstonesrateinoperation.

Keywordscholedoch