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经T管窦道经皮取出胆囊切除术后残留结石

Percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract.

作者信息

Sobstyl Jan, Sojka Michał, Kuczyńska Maryla, Światłowski Łukasz, Kuklik Ewa, Jargiełło Tomasz

机构信息

Department of Interventional Radiology and Neuroradiology, Medical University in Lublin, Poland.

出版信息

Pol J Radiol. 2018 May 7;83:e183-e188. doi: 10.5114/pjr.2018.75811. eCollection 2018.

Abstract

PURPOSE

In the present study, the effectiveness and safety of minimally invasive percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract were assessed.

MATERIAL AND METHODS

Between 2000 and 2015, 12 patients (seven women and five men, mean age 78 ± 8 years) after open cholecystectomy with common bile duct exploration and T-tube drainage underwent percutaneous extraction of residual gallstones through the T-tube tract.

RESULTS

The intervention was successful in 92% (11/12). In seven patients complete extraction of the retained gallstones was achieved, and in four cases partial extraction combined with passage of small residual fragments to the duodenum was obtained. In one case the extraction attempt was ineffective. Mild haemobilia was observed in two patients. No mortality or major complications were observed.

CONCLUSIONS

Our findings are consistent with literature data and confirm that percutaneous extraction of residual post-cholecystectomy gallstones through the T-tube tract is an effective and safe treatment method. Although the presented technique is not a novel approach, it can be beneficial in patients unsuitable for open surgery or laparoscopic intervention when ERCP attempt occurs ineffective or there exist contraindications to ERCP.

摘要

目的

在本研究中,评估了经T管窦道微创经皮取出胆囊切除术后残余结石的有效性和安全性。

材料与方法

2000年至2015年间,12例(7例女性,5例男性,平均年龄78±8岁)接受了开腹胆囊切除术、胆总管探查及T管引流的患者经T管窦道进行了残余结石的经皮取出。

结果

干预成功率为92%(11/12)。7例患者实现了残留结石的完全取出,4例患者部分取出结石并使小的残余碎片排入十二指肠。1例患者的取出尝试无效。2例患者出现轻度胆血反流。未观察到死亡或严重并发症。

结论

我们的研究结果与文献数据一致,并证实经T管窦道经皮取出胆囊切除术后残余结石是一种有效且安全的治疗方法。尽管所介绍的技术并非新方法,但当ERCP尝试无效或存在ERCP禁忌证时,对于不适合开放手术或腹腔镜干预的患者可能有益。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/53be/6323596/216081de77f5/PJR-83-75811-g001.jpg

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本文引用的文献

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Evidence-based current surgical practice: calculous gallbladder disease.循证当前外科实践:胆囊结石病。
J Gastrointest Surg. 2012 Nov;16(11):2011-25. doi: 10.1007/s11605-012-2024-1. Epub 2012 Sep 18.
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Management of suspected stones in the common bile duct.胆总管可疑结石的处理
CMAJ. 2012 May 15;184(8):884-92. doi: 10.1503/cmaj.110896. Epub 2012 Apr 16.
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Biliary and pancreatic stone extraction devices.胆胰结石取出装置。
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