Liguory C, Lefebvre J F, Bonnel D, Vitale G
Centre Médico-Chirurgical de l'Alma, Paris.
Chirurgie. 1990;116(3):251-6.
The endoscopic treatment of calculi of the main biliary duct (CMBD) has been performed in France since 1974. One of us (Cl. L.) published his results with a series of 323 patients in 1979. The stones were extracted in 86.5% of all cases, the failures being caused by the impossibility to perform endoscopic sphincterotomy (ES) in 4.3% of cases or to extract the stones in 9.2%. Since that date, a number of factors helped improving the effectiveness of endoscopic treatment: the increasing experience of the surgeons, the improvement of endoscopes, especially more appropriate optics (wide angle and 15 degrees retrograde vision) and the endoscopic approach of the biliary tract, the use of intraoperative radiology allowing access to the biliary tract in all cases, and the development of extra- and intracorporeal lithotrity solving the problem of stones that cannot be extracted by conventional means. This work is aimed at demonstrating the current possibilities of the endoscopic treatment of lithiasis of the CMBD in a Hospital using plain radiology and lithotrity.
自1974年以来,法国一直在开展主胆管结石(CMBD)的内镜治疗。我们中的一人(Cl. L.)在1979年发表了对323例患者的治疗结果。在所有病例中,86.5%的结石被取出,4.3%的病例因无法进行内镜括约肌切开术(ES)而失败,9.2%的病例因无法取出结石而失败。自那时起,一些因素有助于提高内镜治疗的有效性:外科医生经验的增加、内镜的改进,特别是更合适的光学系统(广角和15度逆行视野)以及胆道的内镜入路、术中放射学的应用使得在所有病例中都能进入胆道,以及体外和体内碎石术的发展解决了无法通过传统方法取出的结石问题。这项工作旨在展示在一家使用普通放射学和碎石术的医院中,内镜治疗CMBD结石的当前可能性。