Chen M F, Jan Y Y
Department of Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, Republic of China.
Br J Surg. 1990 May;77(5):530-2. doi: 10.1002/bjs.1800770519.
Since 1983, 14 patients with intrahepatic and common bile duct stones have undergone percutaneous transhepatic cholangioscopic lithotripsy because the stones were too large to be removed using ordinary percutaneous transhepatic cholangioscopy. Stones were completely fragmented in seven cases (six with intrahepatic stones and one with common bile duct stone) and partially disrupted in five cases with intrahepatic stones. Intrahepatic duct angulation and stricture was the factor most often responsible for failure. All the disintegrated stones were removed by subsequent transhepatic cholangioscopy. Amongst the seven patients with complete stone fragmentation, six stones were found with electrohydraulic shock-wave lithotripsy and one with NdYAG laser lithotripsy. Complications of percutaneous transhepatic cholangioscopic lithotripsy using electrohydraulic shock waves were found in three cases, two had transient haemobilia and one had fever and chills after the procedures. They all recovered by conservative treatment. NdYAG laser treatment was expensive, time consuming and inconvenient to use. Percutaneous transhepatic cholangioscopic lithotripsy by using electrohydraulic shock wave is an effective and safe method to fragment biliary stones and to facilitate their removal.
自1983年以来，14例肝内胆管和胆总管结石患者接受了经皮经肝胆道镜碎石术，因为结石太大，无法通过普通的经皮经肝胆道镜取出。7例结石完全破碎（6例为肝内结石，1例为胆总管结石），5例肝内结石部分破碎。肝内胆管成角和狭窄是最常见的失败因素。所有破碎的结石均通过随后的经肝胆道镜取出。在7例结石完全破碎的患者中，6例使用电液压冲击波碎石术，1例使用Nd:YAG激光碎石术。使用电液压冲击波进行经皮经肝胆道镜碎石术的并发症在3例中出现，2例出现短暂性胆道出血，1例术后出现发热和寒战。他们均通过保守治疗康复。Nd:YAG激光治疗昂贵、耗时且使用不便。使用电液压冲击波进行经皮经肝胆道镜碎石术是一种有效且安全的方法，可破碎胆管结石并便于其取出。
