摘要
对４１例经内镜乳头括约肌切开术（ＥＳＴ）难以清除的胆总管结石患者做经内镜机械性碎石术（ＥＭＬ）。结石共８９块，３１例（３４块）结石横径≥２０ｍｍ，全部结石清除率９７．６％。ＥＭＬ后１次完全清除结石率为：大切开时为７８．６％，中小切开时分别为５８．８％与０；胆管末端径≥１４ｍｍ者为８３．３％，＜９ｍｍ者为３０．８％；取石篮为６／１０，气囊导管为４／９，两者并用为８３．３％，１周内自然排石为１／５。结论：ＥＭＬ后清除结石主要与乳头切开大小、胆管末端径以及取石方法相关；结石大且与胆管壁密切接触时，向胆管内注入大量稀释的造影剂能增加其间隙，有利于套石；结石坚硬是碎石失败的原因之一。
Endoscopicmechanicallithotripsy(EML)wasatemptedin41patientswithcommonbileductstonesunabletoberemovedbyendoscopicsphincterotomy.Thesepatientshadaltogether89stoneswithstonesizerangedfrom5to30mm(meantransversedaimeter16.6±6.0mmandmeanlongi-tudinaldiameter20.0±7.1mm).31patientshad34stonesgreaterthanorequalto20mmintransversediameter.Theoveralstoneremovalratewas97.6%.Therateofcompleteremovalofthestonefrag-mentswithEMLatonetimewas78.6%(11/14)forlarge,58.8%(10/17)formiddleand0(0/5)forsmalincisionofthesphincter.Inpatientswithdiameterofthedistalcommonbileductgreaterthanorequalto14mmandlesthan9mmtheratewas83.3%and30.8%respectivelyandthediferencewasofsignificance(P<0.05).Therateofcompleteremovalforusingbasketandbalooncatheterwas6/10and4/9separatelyandthatforcombinedusedofthesetwomethods83.3%(10/12).Therateofspon-taneouspassageofthestone(withinonewek)was1/5.Itisconcludedthatcompleteremovalofthestonefragmentswasrelatedmainlytothelengthoftheincision,diameterofdistalcommonbileductandmethodsofremovingstonefragmentsafterthecrushwithlithotripsybasket;whenthestoneislargeandthereisthenospacearoundthestoneforlithotripsybasketmanipulation,alargeamountofdilutedcontrastmaterialisinjectedintothebileductsoastoincreasethespaceandfacilitatetheen-sonaringofthestonewithlithotripsybasket.Hardstonescannotbecrushedeasily,sotheyconstituteoneofthereasonsoffailure.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1996年第7期447-450,共4页
Chinese Journal of Internal Medicine
基金
黑龙江省"八五"攻关课题
