Geisinger M A, Owens D B, Meaney T F
Department of Hospital Radiology, Cleveland Clinic Foundation, Ohio 44195-5103.
Am J Surg. 1989 Sep;158(3):222-7. doi: 10.1016/0002-9610(89)90255-9.
Fluoroscopically guided extraction of retained common duct calculi through a T-tube tract has a high success rate, low complication rate, and negligible mortality rate. It is not unduly uncomfortable and can be performed on an outpatient basis. The only disadvantage is a wait of approximately 6 weeks after surgery to let the T-tube sinus tract mature. If no T tube is present, endoscopic sphincterotomy is usually the treatment of choice. In difficult cases, the radiologist may be able to assist the endoscopist by placing a wire across the sphincter through a percutaneous transhepatic route. If endoscopic sphincterotomy is not successful or feasible, an attempt at percutaneous stone removal can be made from a transhepatic approach. A variety of new devices and dissolution agents is becoming available for stone fragmentation or reduction.
在荧光透视引导下经T管窦道取出胆总管残留结石成功率高、并发症发生率低且死亡率可忽略不计。该操作不会带来过度不适，且可在门诊进行。唯一的缺点是术后需等待约6周以使T管窦道成熟。如果没有放置T管，通常首选内镜下括约肌切开术。在困难病例中，放射科医生可通过经皮经肝途径将导丝穿过括约肌来协助内镜医生。如果内镜下括约肌切开术不成功或不可行，可尝试经肝途径进行经皮取石。各种新型设备和溶石剂可用于结石破碎或缩小。
