硬镜联合鞘管经T管窦道治疗胆道残余结石的经验和存在问题

【摘要】目的探讨应用硬质胆道镜联合鞘管经T管窦道治疗复杂胆道残余结石的临床经验和存在问题。方法2014年3月~2016年5月，对34例复杂胆道残余结石患者，在连续腰硬麻下行硬质胆道镜联合鞘管经T管窦道探查、取石治疗，对其临床资料进行分析。结果手术操作均成功取石，手术时间45~135 min，平均80 min，取尽结石33例，结石残留1例；无出血、窦道撕裂、胆管穿孔、急性胆管炎等并发症，术后随访4~30月均无发热、腹痛、黄疸等症状，转氨酶、胆红素正常范围。残留结石患者术后18月复查CT见结石大小及位置无明显变化，余患者B超检查无结石复发。结论硬质胆道镜经T管窦道治疗肝内胆管残余结石临床实践安全、可行，联合鞘管取石效率更高，但依赖术者的经验和技巧，有一定的不确定性。

Experience and problem of rigid choledochoscope combined with fibrous sheath through T-tube sinus in the treatment of residual bile duct stones

【Abstract】 Objective To summarize the experience and problems of rigid choledochoscope combined with fibrous sheath through T-tube sinus for treatment of complex residual bile duct stones. Methods The clinical data of 34 patients of residual bile duct stones treated by rigid choledochoscope combined with fibrous sheath through T-tube sinus were analyzed. The clinical efficacy and complications were recorded. Results All surgical procedures were completed smoothly. The time of calculus removed was ranged from 45 to135 minutes and 80 minutes on average. Stones were completely removed in 33 cases and stone was residue in one case. No bleeding, acute cholangitis, injury of bile duct wall and T-tube sinus were found during operation. And none had fever, abdominal pain, jaundice and recurrence in followed-up from 4 to 30 months. Conclusion Rigid choledochoscope combined with fibrous sheath through T-tube sinus existed a good efficiency in the treatment of residual bile duct stones. However, it relied on the experience and skills of the surgeon.