采用气压弹道碎石术治疗复杂的胆囊管结石。

Department of Minimal Access Surgery, Institute of Kidney and Urological Disease Research Center, Sonwar, Srinagar, India.

Int J Surg. 2011;9(1):59-62. doi: 10.1016/j.ijsu.2010.08.009. Epub 2010 Sep 16.

INTRODUCTION

About 7-12% of patients who harbor gallbladder calculi concomitant common bile duct (CBD) calculi are present. The treatment of gallbladder calculi has standardized in the form of laparoscopic cholecystectomy but management of CBD calculi is still evolving. Endoscopic removal of CBD calculi <2 cm in diameter is successful in 90-100% of cases but patients harboring stones >2 cm in diameter high failure rates can be seen. Traditionally, laparoscopically one can achieve success rate comparable to endoscopic surgery but large and impacted calculi may cause failures. If one uses pneumatic lithotripsy during laparoscopic management of CBD calculi one can achieve 100% stone clearance irrespective of size, degree of hardness and impaction. This study evaluates the feasibility of using pneumatic lithotripsy for CBD calculi. To our knowledge this is the 1st reported series of using pneumatic lithotripsy for CBD calculi.

MATERIAL AND METHODS

From June 2002 to June 2010 96 laparoscopic CBD explorations (LCBDE) were done for CBD calculi. Patients having choledocholithiasis with CBD diameter of >10 mm were taken for LCBDE while in patients with CBD diameter of <10 mm were referred for endoscopic clearance. Additionally ERCP failure cases were also subjected to LCBDE. Rigid nephroscope was used for LCBDE and usually calculi were removed by forceps only. In patients having large, hard &/or impacted calculi pneumatic lithotripsy were used for fragmentation.

RESULTS

Out of the 96 patients in 12 (12.5%) cases pneumatic lithotripsy was used for stone fragmentation. Out of these 12 cases 5 (41.6%) were ERCP failure cases. At a mean hospital stay of 2.5 days 100% stone clearance was achieved in all cases with no perioperative complication.

CONCLUSION

The present study shows how successfully pneumatic lithotripsy can be used to fragment large, hard &/or impacted CBD calculi. Pneumatic lithotripsy being user friendly easily available can reliably fragment CBD calculi in one session.

简介

约有 7-12%的同时患有胆囊结石和胆总管（CBD）结石的患者。胆囊结石的治疗已经标准化为腹腔镜胆囊切除术，但 CBD 结石的治疗仍在不断发展。内镜下取出直径<2cm 的 CBD 结石成功率为 90-100%，但直径>2cm 的结石成功率较低。传统上，腹腔镜下的成功率可以与内镜手术相媲美，但大而嵌顿的结石可能会导致失败。如果在腹腔镜处理 CBD 结石时使用气动碎石术，可以实现 100%的结石清除率，而与结石的大小、硬度和嵌顿程度无关。本研究评估了使用气动碎石术治疗 CBD 结石的可行性。据我们所知，这是首例使用气动碎石术治疗 CBD 结石的系列报道。

材料和方法

2002 年 6 月至 2010 年 6 月，我们对 96 例 CBD 结石进行了腹腔镜 CBD 探查术（LCBDE）。对于 CBD 直径>10mm 的胆总管结石患者，我们进行 LCBDE，而对于 CBD 直径<10mm 的患者，则建议进行内镜清除。此外，对于 ERCP 失败的患者，也进行了 LCBDE。我们使用硬性肾镜进行 LCBDE，通常仅使用钳子取出结石。对于大、硬和/或嵌顿结石，我们使用气动碎石术进行碎石。