经窦道取石技术治疗高龄复杂胆结石的现状与进展.PDFVIP

中华普通外科学文献 （电子版） 2018 年 月第 卷第 期 （ ） • • 12 12 6 Chin Arch Gen Surg Electronic Edition , December 2018, Vol. 12, No.6 434 ·综述 · 经窦道取石技术治疗高龄复杂胆结石的 现状与进展 尚培中  李晓武  柳勇  张伟  任爱玲  王金  王铁山  张金江 【摘要】高龄患者手术风险大、结石易残留易复发、胆系凶险感染等困难仍然是治疗胆结石面 临的重要挑战。近年来，经窦道取石技术不断发展，为胆结石的微创治疗提供了新的选择。经皮经 肝胆囊穿刺建立窦道，为高龄、高危、急性结石性胆囊炎患者保胆取石提供了安全有效治疗手段。 经皮经肝胆管穿刺建立窦道，有助于治疗弥漫性肝胆管结石合并胆系化脓性感染；经T 管窦道、胆 囊管导管窦道、U 管窦道以及经皮下盲襻穿刺建立窦道，是治疗胆管残留结石或再生结石的重要 措施。 【关键词】胆结石；残留结石；介入性；胆道镜；碎石术 Stone-removing techniques via sinus for elderly and complicated patients with cholelithiasis Shang Peizhong, Li Xiaowu, Liu Yong, Zhang Wei, Ren Ailing, Wang Jin, Wang Tieshan, Zhang Jinjiang. Department of General Surgery, the 251st Hospital of PLA, Zhangjiakou 075000, China Corresponding author: Li Xiaowu, Email: li_xiaowu@ Abstract 【 】Surgical risks, residual and recurrent stones, and overwhelming infection of the biliary system are still key challenges for cholelithiasis related to high-risk elderly patients. In recent years, stone-removing techniques via sinus has been developed continuously, which provides a new approach for minimally invasive treatment of cholelithiasis. Percutaneous transhepatic gallbladder catheterizing drainage combined with choledochoscopic lithotomy is effective treatment with reliable efficacy for high-risk elderly patients with acute calculous cholecystitis. Percutaneous transhepatic biliary duct catheterization combined with cholangioscopic lithotomy is conducive to treat diffuse hepatolithiasis with acute obstructive cholangitis. Interventional treatment via sinus formed by T-bute, cystic duct tube, U-tube and subcutaneous blind loop are important measures for residual and recurrent stones from the common bile duct and intrahepatic bile d