DPOC 检测和清除残余胆总管结石的临床价值（视频）。
Clinical value of DPOC for detecting and removing residual common bile duct stones (video).
机构信息
Department of Gastroenterology, Lanzhou First People's Hospital, No. 1 of Wujiayuan west Street, Qilihe District, Lanzhou City, 730050, China.
出版信息
BMC Gastroenterol. 2019 Jul 26;19(1):135. doi: 10.1186/s12876-019-1045-6.
BACKGROUND
This study aims to evaluate the efficacy and safety of detecting and removing residual common bile duct stones (CBDS) using direct peroralcholangioscopy (DPOC) after performing endoscopic retrograde cholangiopancreatography (ERCP) for stone retrieval.
METHODS
From January 5, 2017 to December 27, 2017, a total of 164 cases of choledocholithiasis were treated by ERCP for stone retrieval. According to the inclusion and exclusion criteria, the remaining 79 cases (39 males; mean age: 63.3 years old, range: 52-79 years old) were enrolled in the present study. The maximum transverse stone diameter was 6-15 mm (12.7 ± 4.2 mm), as determined by ERCP. Furthermore, there were 57 cases of multiple stones (number of stones: two in 41 cases, three in nine cases, and ≥ 4 in seven cases), 13 cases of post-mechanical lithotripsy, and nine cases of broken stones.
RESULTS
The overall success rate of DPOC was 94.9% (75/79). Furthermore, 18.7%(14/75) of cases were directly inserted, 72%(54/75) of cases required guide wire assistance, and 9.3%(7/75) of cases were successfully inserted with overtube assistance. The average insertion time was 7-17 min (4.9 ± 2.9 min). Residual stones were detected in 19 cases (25.3%), and all of which were < 5 mm in diameter. Moreover, five cases of formed stones were removed by basket and balloon catheter, while the remaining cases were cleaned after irrigation and suction. There were no serious complications.
CONCLUSION
DPOC is safe and effective for both the detection and removal of residual CBDS after conventional ERCP.
背景
本研究旨在评估在进行内镜逆行胰胆管造影术（ERCP）取石后，使用直接经口胆镜（DPOC）检测和清除残余胆总管结石（CBDS）的疗效和安全性。
方法
2017 年 1 月 5 日至 2017 年 12 月 27 日，共有 164 例胆石症患者接受 ERCP 取石治疗。根据纳入和排除标准，本研究共纳入 79 例（39 例男性；平均年龄：63.3 岁，范围：52-79 岁）。通过 ERCP 确定最大横径为 6-15mm（12.7±4.2mm）的结石为残余结石。此外，57 例为多发结石（41 例 2 枚结石，9 例 3 枚结石，7 例≥4 枚结石），13 例为机械碎石后，9 例为碎石残留。
结果
DPOC 的总体成功率为 94.9%（75/79）。其中，18.7%（14/75）直接插入，72%（54/75）需要导丝辅助，9.3%（7/75）需要使用外套管辅助插入。平均插入时间为 7-17min（4.9±2.9min）。19 例（25.3%）发现残余结石，直径均<5mm。其中 5 例成形结石用篮状取石篮和球囊导管取出，其余通过冲洗抽吸清除。无严重并发症发生。
结论
在常规 ERCP 后，DPOC 是检测和清除残余 CBDS 的安全有效方法。
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