Division of Trauma, Critical Care and General Surgery, Mayo Clinic, Rochester, MN 55901, USA.
World J Gastroenterol. 2010 Mar 28;16(12):1533-6. doi: 10.3748/wjg.v16.i12.1533.
The surgical management of gallstone ileus is complex and potentially highly morbid. Initial management requires enterolithotomy and is generally followed by fistula resection at a later date. There have been reports of gallstone extraction using various endoscopic modalities to relieve the obstruction, however, to date, there has never been a published case of endoscopic stone extraction from the colon using electrohydraulic lithotripsy. In this report, we present the technique employed to successfully perform an electrohydraulic lithotripsy for removal of a large gallstone impacted in the sigmoid colon. A cavity was excavated in an obstructing 4.1 cm lamellated stone in the sigmoid colon using electrohydraulic lithotripsy. A screw stent retractor and stent extractor bored a larger lumen which allowed for guidewire advancement and stone fracture via serial pneumatic balloon dilatation. The stone fragments were removed. Electrohydraulic lithotripsy is a safe and effective method to treat colonic obstruction in the setting of gallstone ileus.
胆石性肠梗阻的手术治疗较为复杂，且具有潜在的高度病态性。初始治疗需要进行取石术，通常在日后再进行瘘管切除术。已有使用各种内镜方法提取胆石以解除梗阻的报道，然而，迄今为止，从未有过使用电液压碎石术从结肠中提取内镜下结石的发表病例。在本报告中，我们介绍了成功实施电液压碎石术以去除嵌顿在乙状结肠中的大结石的技术。使用电液压碎石术在乙状结肠中的一个 4.1 厘米层状梗阻性结石中挖掘出一个腔。螺旋支架扩张器和支架取出器在更大的腔中钻孔，允许导丝推进，并通过连续的气动球囊扩张进行结石破裂。取出了结石碎片。电液压碎石术是治疗胆石性肠梗阻中结肠梗阻的一种安全有效的方法。
