Sheen-Chen S M, Chou F F, Lee C M, Cheng Y F, Lee T Y
Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung Hsien, Taiwan, Republic of China.
Gastrointest Endosc. 1993 Mar-Apr;39(2):168-71. doi: 10.1016/s0016-5107(93)70059-0.
Hepatolithiasis with intrahepatic biliary strictures, more common in Southeast Asia than elsewhere, remains a difficult problem to manage. Retention of stones behind strictures after surgery is a frequent and troublesome complication. Post-operative duct dilation with percutaneous transhepatic cholangioscopy tube stenting through a matured T-tube tract was performed in 15 patients. Choledochoscopic electrohydraulic lithotripsy was applied in six patients when impacted or large stones were encountered. Complete clearance of stones was achieved in 12 patients (80%). Two patients had fevers develop after ductal dilation and recovered after conservative treatment. These 12 successfully treated patients remain well, with a mean follow-up of 18 months. Post-operative T-tube tract dilation, selectively combined with endoscopic electrohydraulic lithotripsy, is an effective and safe method for complicated hepatolithiasis with biliary strictures.
肝内胆管结石合并肝内胆管狭窄在东南亚地区比其他地方更为常见，仍然是一个难以处理的问题。手术后结石残留于狭窄部位后方是一种常见且棘手的并发症。对15例患者通过成熟的T管窦道进行经皮经肝胆道镜置管引流以扩张术后胆管。当遇到嵌顿性结石或较大结石时，对6例患者应用了胆道镜下液电碎石术。12例患者（80%）结石完全清除。2例患者在胆管扩张后出现发热，经保守治疗后康复。这12例成功治疗的患者情况良好，平均随访18个月。术后T管窦道扩张，选择性地联合内镜下液电碎石术，是治疗合并胆管狭窄的复杂肝内胆管结石的一种有效且安全的方法。
