CAJ | 학술논문

目的：探讨术中胆道镜联合液电碎石治疗难治性肝内胆管结石的治疗策略和临床价值。方法11例难治性肝内胆管结石患者，术中经直视及胆道镜下对患者肝实质、肝内胆管及结石状况进行探查、评估。对拟保留肝叶内的胆管结石采用胆道镜下液电碎石、取石，一次无法取净的患者，二期经窦道胆道镜下液电碎石、取石。结果所有11例患者经术中或二期碎石，均取净结石，治疗成功率100％。手术顺利，术后无手术并发症。本组随访10例，失访1例，随访时间1～3年。3例停用熊去氧胆酸片1～2年后复发肝内胆管小结石，其余7例患者随访期间未见复发。结论术中胆道镜联合液电碎石在有效保证难治性肝内胆管结石治疗成功的同时，最大程度的保护了肝组织，降低了治疗难度及手术风险，减少了术后并发症的发生，提高了患者的生存质量。
목적：탐토술중담도경연합액전쇄석치료난치성간내담관결석적치료책략화림상개치。방법11례난치성간내담관결석환자，술중경직시급담도경하대환자간실질、간내담관급결석상황진행탐사、평고。대의보류간협내적담관결석채용담도경하액전쇄석、취석，일차무법취정적환자，이기경두도담도경하액전쇄석、취석。결과소유11례환자경술중혹이기쇄석，균취정결석，치료성공솔100％。수술순리，술후무수술병발증。본조수방10례，실방1례，수방시간1～3년。3례정용웅거양담산편1～2년후복발간내담관소결석，기여7례환자수방기간미견복발。결론술중담도경연합액전쇄석재유효보증난치성간내담관결석치료성공적동시，최대정도적보호료간조직，강저료치료난도급수술풍험，감소료술후병발증적발생，제고료환자적생존질량。
Objective To explore the therapeutic strategy and clinical value of intraoperative chole-dochoscopy and electrohydraulic lithotripsy for refractory intrahepatic bile duct stones.Methods Liver pa-renchyma,intrahepatic bile duct and bile duct stones were explored under direct vision and intraoperative choledochoscope in 1 1 cases of refractory intrahepatic bile duct stones.Electrohydraulic lithotripsy and lithot-omy were performed to remove the stones and protect the liver parenchyma.If the stones could not be re-moved once,a secondary lithotripsy and lithotomy was performed through the fistula tract.Results All re-fractory calculi were crushed after one or two procedures and the clearance rate were 100%.No complica-tions occurred.Ten patients were followed up from 1 to 3 years except one.Three cases revealed recurrent stone during follow-up due to withdrawal of ursodeoxycholic acid capsules in 1 to 2 years.Seven others showed no stone recurrence within follow-up time.Conclusion Intraoperative choledochoscopy and electro-hydraulic lithotripsy is an easy technique and can effectively protect the liver parenchyma.The life quality of patients can be improved with low surgical risk and postoperative complications.