Zakko S F, Srb S, Ramsby G R
Department of Medicine, University of Connecticut Health Center, Farmington 06030, USA.
Gastrointest Endosc. 1995 Nov;42(5):434-8. doi: 10.1016/s0016-5107(95)70046-3.
Early gallstone recurrence in some patients after "successful" percutaneous topical dissolution may be due to residual debris. An endoscope small enough to be introduced without dilating the existing percutaneous track was used for gallbladder examination after stone dissolution.
The sensitivity of gallbladder endoscopy was compared with ultrasonography and double-contrast cholecystography for the detection of residual debris or mucosal lesions in 18 patients who underwent percutaneous topical dissolution. All examinations were performed before catheter removal and after the gallbladder was deemed stone-free by the traditionally employed technique of single-contrast cholecystography.
Residual debris was detected in only one patient by ultrasonography and in none of the 18 patients by double-contrast cholecystography, yet endoscopy showed stone fragments ranging from 1 to 3 mm in 13 of the 18 patients. In all these patients, catheter repositioning and additional solvent perfusion resulted in elimination of the debris as assessed endoscopically. Two patients had endoscopically detected erosions. Double-contrast fluoroscopy found only one of these, whereas ultrasonography detected neither.
Percutaneous gallbladder endoscopy is a more sensitive imaging modality for the detection of residual stone debris or mucosal lesions after gallstone dissolution.
部分患者在“成功”进行经皮局部溶石后早期胆结石复发可能是由于残留碎片。一种足够小、无需扩张现有经皮通道即可插入的内窥镜被用于溶石后胆囊检查。
对18例行经皮局部溶石的患者，比较胆囊内窥镜检查与超声检查及双重对比胆囊造影在检测残留碎片或黏膜病变方面的敏感性。所有检查均在拔除导管前进行，且在通过传统的单对比胆囊造影技术判定胆囊无结石后进行。
超声检查仅在1例患者中检测到残留碎片，双重对比胆囊造影在18例患者中均未检测到残留碎片，但内窥镜检查显示18例患者中有13例存在1至3毫米大小的结石碎片。在所有这些患者中，经内窥镜评估，重新放置导管并额外灌注溶剂可清除碎片。2例患者经内窥镜检测到糜烂。双重对比荧光透视仅发现其中1例，而超声检查均未检测到。
经皮胆囊内窥镜检查是检测胆结石溶解后残留结石碎片或黏膜病变更敏感的成像方式。
