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经腔内金属支架行内镜激光碎石取石术治疗巨大胆囊结石的疗效及安全性

Efficacy and safety of endoscopic laser lithotripsy and lithotomy through the lumen-apposing metal stent for giant gallbladder stones.

作者信息

Wang Wei, Liu Bowei, Qi Ke, Shi Xingang, Jin Zhendong, Li Zhaoshen

机构信息

Department of Gastroenterology, Changhai Hospital, Second Military Medical University/Naval Medical University, Shanghai, China.

Department of Gastroenterology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, School of Clinical Medicine, Henan, China.

出版信息

VideoGIE. 2020 May 7;5(7):318-323. doi: 10.1016/j.vgie.2020.03.005. eCollection 2020 Jul.

DOI:10.1016/j.vgie.2020.03.005
PMID:32642623
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7332785/
Abstract

BACKGROUND AND AIMS

EUS-guided gallbladder drainage has been increasingly applied for acute cholecystitis in high-risk surgical patients. In cases of EUS-guided gallbladder drainage with lumen-apposing metal stents (LAMSs), endoscopic retrieval of gallstones becomes feasible. However, retrieval of giant gallstones is still difficult because of the limited space in the saddle section of the LAMS. In this study, we aimed to evaluate the efficacy and safety of endoscopic laser lithotripsy and lithotomy through LAMSs for the removal of giant gallstones.

METHODS

Five consecutive patients with recurrent cholecystitis due to giant gallstones were enrolled. We proceeded with EUS-guided LAMS implantation. Endoscopic laser lithotripsy and lithotomy then was performed through the LAMSs, and the stents were removed after all stones were extracted. The patients were followed up at scheduled times.

RESULTS

EUS-guided LAMS implantation was successfully performed, and target gallstones were completely removed in all 5 patients. There was no severe bleeding, perforation, or stent migration during the operation. No recurrence of gallstones was found at late follow-up.

CONCLUSIONS

Endoscopic laser lithotripsy and lithotomy through LAMSs could be a safe and effective approach for removal of giant gallstones.

摘要

背景与目的

内镜超声引导下胆囊引流已越来越多地应用于手术高危患者的急性胆囊炎治疗。在内镜超声引导下使用管腔对合金属支架（LAMS）进行胆囊引流的情况下，内镜下取出胆结石变得可行。然而，由于LAMS鞍部空间有限，取出巨大胆结石仍然困难。在本研究中，我们旨在评估通过LAMS进行内镜激光碎石术和取石术治疗巨大胆结石的有效性和安全性。

方法

连续纳入5例因巨大胆结石导致复发性胆囊炎的患者。我们进行了内镜超声引导下的LAMS植入。然后通过LAMS进行内镜激光碎石术和取石术，在所有结石取出后取出支架。对患者进行定期随访。

结果

成功进行了内镜超声引导下的LAMS植入，所有5例患者的目标胆结石均被完全取出。术中未发生严重出血、穿孔或支架移位。随访后期未发现胆结石复发。

结论

通过LAMS进行内镜激光碎石术和取石术可能是一种安全有效的治疗巨大胆结石的方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/202bbb6014dd/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/9fa4b3d555fb/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/1021bf1244d4/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/202bbb6014dd/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/9fa4b3d555fb/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/1021bf1244d4/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fe1c/7332785/202bbb6014dd/gr3.jpg

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