摘要
目的:内镜逆行胰胆管造影术(ERCP)是目前去除胆总管结石的主要方式，在ERCP手术中，患者单次手术的辐射损害，以及术者多次手术的累积辐射损害是一个不可忽视的问题。胆道镜的出现让手术中的间接影像变成直接影像，可以大幅度减少术中透视的需求，本研究将初步探索胆道镜直视下去除胆总管小结石和泥沙样结石的可行性及安全性。方法:选取2022年7月至2022年9月经解放军总医院第一医学中心消化内科医学部诊断为胆总管结石(结石直径≤1 cm，或泥沙样结石)，既往未行ERCP的8例患者。前瞻性收集并分析8例患者的临床特点及治疗效果。结果:8例患者中，4例接受胆道镜直视下网篮取石、4例的结石在乳头支撑器的辅助下负压吸引取出。所有患者均在一次手术中将结石取净，1例患者出现术后胰腺炎。结论:本研究初步证实了胆道镜直视下去除胆总管小结石和泥沙样结石的可行性及安全性。
Abstract
Objective:Currently, endoscopic retrograde cholangiopancreatography(ERCP)is the main modality for the removal of common bile duct stones.During ERCP procedures, radiation damage to the patient from a single procedure, as well as cumulative radiation damage to the operator from multiple procedures, is a problem that can′t be ignored. The advent of cholangioscopy has allowed indirect images during the procedure to become direct images, which can substantially reduce the need for intraoperative fluoroscopy.In this study, we explored the feasibility and safety of extraction for small-caliber and sediment-like common bile duct stones under cholangioscopy.Methods:Eight patients diagnosed with CBDSs (stones≤1 cm in diameter, or sediment-like stones) without previous ERCP at PLA General Hospital First Medical Center, from July 2022 to September 2022, were included. The clinical characteristics and treatment outcomes of the 8 patients were prospectively collected and analyzed.Results:The extraction of CBDSs by basket catheter under cholangioscopy was achieved in four cases, and the remaining four cases received aspiration extraction. Technical success was achieved in all 8 cases in a single procedure and one patient developed postoperative pancreatitis.Conclusion:This study initially demonstrated the feasibility and safety of extraction for small-caliber and sediment-like common bile duct stones under direct view of the choledochoscope.
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