胆道留置导丝取石法在胆管大结石治疗中的应用

Application of retained guide wire lithotomy in large bile duct stones

摘要:

目的 探讨胆道留置导丝取石在胆管大结石治疗中的安全性及应用价值。方法 回顾性分析2017年1月－2019年12月该院收治的308例胆管大结石（1.2～1.5 cm）患者的临床资料。其中，网篮组152例，气囊组42例，联合组38例，导丝组76例，分析不同取石方法的效果。结果 308例患者均成功取石或置入胆道塑料支架。导丝组取石成功率高于其他组，但差异无统计学意义（P > 0.05）；导丝组结石嵌顿率较其他组低，差异有统计学意义（P < 0.05）；导丝组内镜逆行胰胆管造影术（ERCP）后并发症总发生率为10.5%（8/76），低于其他组，但差异无统计学意义（P > 0.05）。其中，术后胰腺炎和高淀粉酶血症低于其他组，但差异无统计学意义（P > 0.05），4组患者术后胆管炎比较，差异无统计学意义（P > 0.05），网篮组和联合组各有1例术后迟发性出血，经内镜止血后好转，4组患者均未发生穿孔或死亡等严重并发症。导丝组手术时间明显短于其他组，差异有统计学意义（P < 0.05），住院时间较其他组短，但差异无统计学意义（P > 0.05）。结论 应用胆道导丝留置法联合网篮或者气囊取石，对于1.2～1.5 cm的大结石，能够提高一次性取石成功率，减少结石乳头嵌顿率，缩短ERCP操作时间，是一种安全、有效的操作方法。

Abstract:

Objective To explore the safety and value of retained guide wire in patients with large bile duct stones.Method Clinical data of 308 patients with large bile duct stones (1.2 ~ 1.5 cm in diameter) from January 2017 to December 2019 were analyzed retrospectively. Among of them, 152 cases in net basket group, 42 cases in balloon group, 38 cases in net basket combined with balloon group and 76 cases in wire-guide group. The effect of various methods of stone extraction is analyzed.Result The success rate of stone removal in the wire-guide group was higher than that in the other groups, but there was no statistical difference (P > 0.05); The incidence of stone incarceration in the wire-guide group was significantly lower than that in the other groups (P < 0.05); The total incidence of complications after endoscopic retrograde cholangiopancreatography (ERCP) in the wire-guide group was 10.5% (8/76), lower than that in the other groups, but there was no significant difference (P > 0.05). In the wire-guide group, post-ERCP pancreatitis and hyperamylasemia were lower than those in the other groups, but there were no significant differences (P > 0.05). There was no significant difference in postoperative cholangitis among four groups (P > 0.05). There were 1 case of delayed bleeding in the basket group and 1 case in the combined group, which was improved after endoscopic hemostasis, no perforation or death occurred in all four groups. The operation time of the wire-guide group was significantly shorter than that of the other groups (P < 0.05), and the hospitalization time of the wire-guide group was shorter than that of the other groups, but not statistically significant (P > 0.05).Conclusion The retention of biliary guide wire can improve the success rate of one-time stone extraction, reduce the probability of stone nipple incarceration, shorten the ERCP operation time .