论文部分内容阅读
目的:探讨B超引导下内镜胆管取石的可行性.方法:采用B超引导下十二指肠镜肝外胆管取石、B超探查胆管结石的大小、位置,插入十二指肠镜,找到乳头,调整角度,行乳头切开,插入网篮,B超引导下网篮越过结石,张开网篮,回拉套住结石,收紧网篮,拉出胆管外.多发结石可反复插入网篮取石,化脓性胆管炎或胆源性胰腺炎者先行鼻胆管引流,消除感染和减黄后再行胆管取石.结果:50例患者中31例一次取石成功,急性化脓性胆管炎和急性胆源性胰腺炎共13例,行EST和ENBD1wk后取石全部成功,6例乳头切开后取石未成功,1wk后4例再行取石成功,2例1wk后复查B超结石自行排出.取出结石62粒,结石大小为0.3×0.5cm-1.3×2.5cm.症状全部消失45例,5例合并有胆囊炎或胆囊结石上腹部疼痛持续时间较长.8例出现血尿淀粉酶增高,血淀粉酶最高800单位/dl(正常180单位/dl),72h恢复正常.18例出现术后腹部隐痛或胀痛,12-24h内完全消失.1例出现消化道出血,经止血、输血后出血控制.结论:通过50例B超引导内镜下胆管取石表明,只要操作上有一定经验,成功率就比较高,对医患双方都比较安全,彻底解决了电离辐射的防护问题,减少了造影剂造成的注射性胰腺炎等并发症,通过进一步总结经验,不断实践,B超引导内镜下胆管取石将成为治疗肝外胆管结石的有效方法.
Objective: To explore the feasibility of B-guided endoscopic cholangiolithotomy.Methods: B-guided duodenoscopic extrahepatic bile duct lithotripsy was performed to detect the size and location of bile duct stones, Nipple, adjust the angle, the line nipple incision, insert the basket, B-guided basket over the stones, open the basket, pull the sleeve to live the stones, tighten the basket, pull out the bile duct. Multiple stones can be repeatedly inserted into the network Basket stone, suppurative cholangitis or biliary pancreatitis were nasogastric biliary drainage, eliminate infection and reduce the yellow bile duct stone.Results: 50 patients in 31 cases of a successful stone, acute suppurative cholangitis and acute gallbladder A total of 13 cases of pancreatitis derived from EST and ENBD1wk after the stone was completely successful, 6 cases of nipples after the removal of stone was unsuccessful, 1wk after 4 cases of stone again succeeded, 2 cases of 1wk after the review of B-stones to remove stones 62 Tablets, stones size 0.3 × 0.5cm-1.3 × 2.5cm. Symptoms disappeared in 45 cases, 5 cases with cholecystitis or gallstones upper abdominal pain longer duration .8 cases of hematuria increased amylase, blood amylase highest 800 units / dl (normal 180 units / dl), 72h returned to normal 18 cases of postoperative abdominal hidden Or pain, completely disappeared within 12-24h .1 cases of gastrointestinal bleeding after hemostasis, bleeding control after transfusion.Conclusion: 50 cases of B-guided endoscopic bile duct stones show that as long as the operation has some experience, the success rate Is relatively high, both doctors and patients more secure, completely solved the problem of ionizing radiation protection, reducing the contrast agent caused by pancreatitis and other complications of injection, through further experience and practice, B-guided endoscopic bile duct Stone will be an effective treatment for extrahepatic bile duct stones.