摘要
目的探讨超细胆道镜经皮经肝治疗胆囊息肉样病变的价值。方法采用经皮经肝穿刺胆囊置鞘建立新鲜内镜通道，插入超细胆道镜（直径2．7mm）用活检钳、圈套器或网篮将息肉取出，置入引流管，10d后拔管。如穿刺点落在胆囊床上但进镜观察不满意，或穿刺点落在体部非胆囊床上，则先放置10．2F引流管，形成窦道后进镜取息肉。结果42例患者均穿刺成功。40例准确穿中胆囊床，并建立新鲜内镜通道，平均用时45min。被穿中胆囊床的29例单纯胆囊底部及体部腹面息肉中，有27例经新鲜通道1次进镜取净，1次进镜取净率为93．10％。42例中9例于穿刺后出现少量胆道出血，3例于穿刺后出现胆道感染。术后随访平均15个月，未发现息肉复发。结论应用超细胆道镜经皮经肝治疗胆囊息肉样病变是可行的，对于良性息肉者，可得到微创的治疗并保留胆囊；对于恶性息肉者则能确诊并有可能早期发现，为进一步治疗提供依据。
Objective To evaluate the therapeutic effect of extra-fine choledochoscope in treating polypoid lesions of gallbladder by percutaneous trans-hepatic and trans-gallbladder puncture （PTGB）. Methods Extra-fine choledochoscope（2. 7 mm diameter） was inserted into tract soon after it was made percutaneously trans-hepatic and dilated in one session, gallbladder polyps was removed with biopsy forceps or snare or basket, and PTCD drainage tube （ 10. 2 F diameter） was imbedded for external drainage until 10 days after. If the gallbladder puncture point fell on the bed and gallbladder polyps were not clearly visualized, or puncture points were on non-gallbladder bed of the body, drainage tube （ 10. 2 F diameter） was placed for external drainage. Results Forty-two patients were successfully punctured, and 40 patients were punctured accurately on the bed in, and the fresh endoscope tract of these patients was established in 45 minutes on average. Of the 29 cases of simple bottom and body ventral polyps, complete clearance of gallbladder polyps was achieved in 27. Gallbladder polyps clearance rate was 93. 10%. Complications of minor hemobilia occurred in 9 cases, and infection of biliary tract occurred in 3 cases after operation. There was no recurrence after a follow-up of 15 months on average. Conclusion Extra-fine choledochoscope by PTGB is a less invasive, more reliable and effective method to cure benign polypoid lesions of the gallbladder. The gallbladder is preserved and for malignant polyps, it can help to achieve early diagnosis and provide reliable evidence for further treatment.
出处
《中华消化内镜杂志》
2008年第4期182-184,共3页
Chinese Journal of Digestive Endoscopy
基金
深圳市医学重点专科及科技计划（JH200507130985A）
关键词
胆囊疾病
超细胆道镜
经皮经肝胆囊穿刺
Gallbladder diseases
Extra-fine choledochoscope
Percutaneous trans-hepatic and trans-gallbladder puncture
