Brambs H J
Abteilung für Radiologische Diagnostik, Radiologische Universitätsklinik Tübingen.
Praxis (Bern 1994). 1994 Nov 15;83(46):1288-91.
Percutaneous transhepatic cholangioscopy by means of small caliber endoscopes is a relatively safe and reliable technique and may be the optimal approach to the percutaneous evaluation and treatment of a variety of complex biliary tract processes. This technique combines the advantages of an endoscopic and a radiologic approach to the bile ducts. This procedure is rarely indicated to assess a biliary stenosis macroscopically and histologically because less invasive techniques have been developed to obtain histological material. The most frequent indication is the diagnosis, fragmentation and removal of bile duct stones. Small stones can be grasped and removed by means of Dormia-baskets. For the treatment of huge and impacted stones laser energy or electrohydraulic shock waves can be applied under endoscopic control. In selected cases of tumorous obstruction such as tumor ingrowth within implanted metallic stents, a tumor ablation can be performed using laser, electrocoagulation or injection of alcohol or cytostatic drugs.
通过小口径内窥镜进行经皮经肝胆道镜检查是一种相对安全可靠的技术，可能是对各种复杂胆道疾病进行经皮评估和治疗的最佳方法。该技术结合了内镜和放射学方法对胆管检查的优点。由于已经开发出侵入性较小的技术来获取组织学材料，因此很少使用该方法来进行胆道狭窄的宏观和组织学评估。最常见的适应症是胆管结石的诊断、破碎和清除。小结石可以用多尔米亚网篮抓取并取出。对于巨大嵌顿结石的治疗，可以在内镜控制下应用激光能量或电液压冲击波。在某些肿瘤性梗阻病例中，如植入金属支架内肿瘤向内生长，可以使用激光、电凝或注射酒精或细胞抑制药物进行肿瘤消融。
