经十二指肠镜治疗左右肝管结石疗效观察.docVIP

经十二指肠镜治疗左右肝管结石疗效观察【摘要】 目的 探讨经十二指肠镜技术微创治疗左右肝管结石的临床意义。方法 86例确诊为左右肝管结石伴或不伴胆总管结石的患者应用十二指肠镜治疗性ERCP技术行胆总管取石后再行左右肝管取石治疗，观察成功率、并发症发生情况。结果 86例患者81例一次治疗成功，成功率94.1%，所有患者无出血、穿孔及重症胰腺炎发生，12例伴有高淀粉酶血症经禁食抑制胰液分泌治疗2~3 d恢复。结论 左右肝管结石经十二指肠镜微创治疗是一种创伤小、安全，有效的治疗方法 【关键词】 十二指肠镜；左右肝管结石；内镜ERCP治疗 The efficacy of treatment the left,right hepatic ducts stone with duodenoscope ZOU Yong,jun, DU Xue,mei, WANG Bo, et al. Department of Digestive Endoscopy, Hepatology Hospital of Jilin Province, Changchun 130062,China 【Abstract】 Objective To discuss the clinical significance of minimally invasive treatment on the left,right hepatic ducts stone with duodenoscope. Methods Observed the success rate and the complications of the treatment on the 86 patients, who had been diagnosed as having left,right hepatic ducts stone with or without common bile duct stones, that dislodge the common bile duct stones before dislodge the left,right hepatic ducts stone by application of therapeutic ERCP techniques with duodenoscope. Results 81 cases of the 86 patients have been cured by one,time treatment, and the success rate was 94.1%. All patients had no bleeding, perforation, and severe pancreatitis. 12 cases associated with hyperamylasemia had been cured after 2 or 3 days treatment by absolute diet to inhibition the pancreas secretion. Conclusion The results show that the minimally invasive treatment with duodenoscope on the patients with left,right hepatic duct stones has the features with small wounds, safe and effective. 【Key words】 Duodenoscope; Left,right hepatic duct stones; ERCP endoscopic treatment 随着十二指肠镜治疗性ERCP技术的发展，对胆总管结石进行内镜下微创取石已成为一种常规有效的治疗方法，但对左右肝管结石的内镜治疗报道较少，肝内胆管结石是我国常见病，常易合并胆管狭窄，化脓性胆管炎和肝内胆管癌。胆总管结石常伴有左右肝管结石，传统的治疗方法多以外科开腹手术为主，操作复杂，并发症多创伤较大，我院2007年6月至2011年6月通过十二指肠镜ERCP技术微创治疗左右肝管结石86例，取得了较好疗效，现报告如下 1 资料与方法 1.1 一般资料 86例患者均为我院住院患者，男48例，女38例，年龄：25~83岁，平均57岁。所有患者均有不同程度右上腹痛、发热等症状，均经腹部超声或CT及核磁共振检查确诊，术中胆管造影进一步明确诊断，其中胆总管结石伴左右肝管结石68例，单纯左肝管结石11例，右肝管结石7例。左右肝管结石最大直径1.0 cm，27例伴有远端狭窄，胆囊切除术后胆管结石28例，合并梗阻化