Nitsche R, Fölsch U R
Gut. 1991 Mar;32(3):329-31. doi: 10.1136/gut.32.3.329.
A postoperative T tube cholangiogram after cholecystectomy in a 62 year old patient showed two retained calculi of 14 mm diameter each. Endoscopic sphincterotomy was not possible because of previous Billroth II gastrectomy. The stones were disintegrated by electromagnetically generated extracorporeal shock waves. The T tube was replaced by a balloon catheter and the papilla of Vater was dilatated allowing passage of stone fragments. We conclude that retained bile duct stones can be removed without sphincterotomy or percutaneous extraction by extracorporeal shock wave lithotripsy and papillary dilatation. This method should be considered especially in patients with Billroth II gastrectomy.
一名62岁患者在胆囊切除术后进行的术后T管胆管造影显示，有两颗直径均为14毫米的残留结石。由于之前做过毕罗Ⅱ式胃切除术，无法进行内镜下括约肌切开术。通过电磁产生的体外冲击波将结石粉碎。T管被球囊导管取代，十二指肠乳头被扩张，使结石碎片得以通过。我们得出结论，残留胆管结石可以通过体外冲击波碎石术和乳头扩张术在不进行括约肌切开术或经皮取石的情况下取出。对于毕罗Ⅱ式胃切除术患者，尤其应考虑这种方法。
