Ray A Andrew, Davies Edward T, Duvdevani Mordechai, Razvi Hassan, Denstedt John D
Department of Surgery, Division of Urology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ont.
Can J Surg. 2009 Oct;52(5):407-12.
Complicated choledocholithiasis cannot always be managed by standard surgical, radiologic or endoscopic methods. One additional approach is to use percutaneous techniques developed by endourologists to treat renal calculi. In this report, we present our experience over the past 10 years with this novel approach.
We conducted a retrospective review of all patients who underwent percutaneous, endoscopic treatment of biliary calculi at our institution between January 1997 and August 2007. Primary outcomes of interest were symptom- and stone-free rates, length of stay in hospital and complications.
Nineteen patients underwent 21 percutaneous treatments for biliary calculi. All were dependent on external drainage for symptom control. The primary indications for treatment were cholangitis, retained stone, biliary colic and jaundice. Seventeen patients (89.5%) had failed prior endoscopic retrograde cholangiopancreatography (ERCP) or open attempts at treatment. The 2 remaining patients (10.5%) were deemed unfit for a general anesthetic. Patients had experienced a mean of 1.8 (standard deviation [SD] 1.0) prior failed attempts at stone removal. We used several treatment modalities, including holmium:yttrium-aluminum-garnet laser (61.9%), electrohydraulic lithotripter (19.0%), ultrasound (9.5%), basket extraction (9.5%) and balloon dilatation of the ampulla (19.0%). Overall, treatment led to successful removal of the biliary drainage tube in 94.7% of patients and 76.2% were stone-free. We performed cholangiograms an average of 21.8 (SD 13.7) days after treatment. The average length of stay in hospital was 1.9 (SD 1.1) days. One patient experienced a perioperative acute coronary syndrome and another experienced prolonged biliary drainage. Both had successful endoscopic treatment of their calculi. There were no cases of treatment-related sepsis, and we observed no other complications.
Biliary calculi may be successfully treated using standard endourologic methods with high stone-free rates. This technique is generally well-tolerated even among high-risk patients.
复杂胆总管结石并非总能通过标准的外科、放射学或内镜方法处理。另一种方法是采用由泌尿外科医生开发的经皮技术来治疗肾结石。在本报告中，我们介绍过去10年我们采用这种新方法的经验。
我们对1997年1月至2007年8月间在我院接受经皮内镜治疗胆管结石的所有患者进行了回顾性研究。主要关注的结果是症状缓解率、结石清除率、住院时间和并发症。
19例患者接受了21次经皮胆管结石治疗。所有患者均依赖外部引流来控制症状。治疗的主要适应证为胆管炎、残留结石、胆绞痛和黄疸。17例患者（89.5%）先前的内镜逆行胰胆管造影（ERCP）或开放治疗尝试失败。其余2例患者（10.5%）被认为不适合全身麻醉。患者平均有1.8次（标准差[SD]1.0）先前的取石失败尝试。我们使用了多种治疗方式，包括钬：钇铝石榴石激光（61.9%）、液电碎石术（19.0%）、超声（9.5%）、网篮取石（9.5%）和壶腹球囊扩张（19.0%）。总体而言，治疗使94.7%的患者成功拔除胆管引流管，76.2%的患者结石清除。治疗后平均21.8天（SD 13.7）进行胆管造影。平均住院时间为1.9天（SD 1.1）。1例患者围手术期发生急性冠状动脉综合征，另1例患者胆管引流时间延长。二者的结石均经内镜治疗成功。无治疗相关败血症病例，且未观察到其他并发症。
使用标准的泌尿外科方法可成功治疗胆管结石，结石清除率高。即使在高危患者中，该技术通常也耐受性良好。
