Schmitt W, von Sanden H, Wegerle W, Ottenjann R
Medizinische Abteilung, Krankenhaus Neuperlach, München.
Leber Magen Darm. 1991 May;21(3):116, 119-20, 122-4.
Cholangioscopy is possible via the peroral or the transhepatic route. Cholangioscopy is of diagnostic value in tumour strictures and stenoses of the common bile duct. More important than diagnostic cholangioscopy is therapeutic cholangioscopy: with the technique of intracorporeal shockwave lithotripsy nearly all difficult CBD-stones may be successfully treated. 17 patients with 40 CBD-stones were managed in mother-babytechnique in applicating intraductal shockwaves under direct visual control (electrohydraulic principle). Mechanical lithotripsy during ERCP had formerly failed in all patients. In 6 patients transhepatic cholangioscopy with intracorporeal shockwave lithotripsy was successfully performed. Patients had an operated stomach, so conventional ERCP with lithotripsy was not possible. 18 stones could be treated. As a total 23 patients with 58 CBD-Stones underwent cholangioscopy (median stone diameter 20 mm) with intracorporeal shockwave lithotripsy. Complete stone clearance was achieved in all cases, no serious complication occurred.
胆管镜检查可通过经口或经肝途径进行。胆管镜检查在胆总管肿瘤性狭窄和狭窄方面具有诊断价值。治疗性胆管镜检查比诊断性胆管镜检查更重要：采用体内冲击波碎石技术，几乎所有难处理的胆总管结石都可成功治疗。17例患有40颗胆总管结石的患者采用母婴技术，在直视控制下（电液压原理）应用导管内冲击波进行治疗。以前所有患者在ERCP期间进行机械碎石均失败。6例患者成功进行了经肝胆管镜检查并结合体内冲击波碎石术。患者曾接受胃部手术，因此无法进行常规的ERCP碎石术。18颗结石得到治疗。总共有23例患有58颗胆总管结石的患者接受了胆管镜检查（结石中位直径20毫米）并结合体内冲击波碎石术。所有病例均实现结石完全清除，未发生严重并发症。
