胆总管冲洗对减少胆管取石术后残石的影响

Effect of common bile duct irrigation on reducing residual stone after bile duct lithotomy

摘要:

目的 在胆总管取石术后使用100 mL的0.9%氯化钠注射液冲洗胆总管，观察是否能提高残石的清除率。方法 纳入该院接受内镜逆行胰胆管造影术（ERCP）联合碎石术的胆总管结石（ ≥ 12 mm）患者112例，对取石后胆总管造影显示结石完全清除者，行管腔内超声检查术（IDUS），观察有无胆总管残石。根据IDUS下所观察到的残石数量来确定评分：大量结石碎片为1分；少量结石碎片为2分；完全清除为3分。分别在ERCP清除胆总管结石，以及用50 mL和100 mL 0.9%氯化钠注射液冲洗后，行IDUS检查，并对结石数量进行评分。结果 取石术后未予以0.9%氯化钠注射液进行胆总管冲洗时，所有患者均未达到3分；经50 mL 0.9%氯化钠注射液冲洗后，有45例（40.18%）患者评分为3分；经100 mL 0.9%氯化钠注射液冲洗后，有99例（88.39%）患者评分为3分。多因素Logistic回归分析显示，胆总管直径 > 15 mm（OR＾ = 4.90，95%CI：1.19 ~ 22.57，P = 0.013）、胆总管角度（胆总管造影中胆总管的轴线与胆总管壶腹轴线之间的成角）≤140°（OR＾ = 6.92，95%CI：1.83～38.98，P = 0.047）及十二指肠憩室（OR＾ = 4.10，95%CI：1.14 ~ 16.90，P = 0.041）是使用100 mL 0.9%氯化钠注射液冲洗失败的独立危险因素。结论 用100 mL 0.9%氯化钠注射液冲洗胆道，可有效清除碎石术后胆总管残石。

Abstract:

Objective Rinse the common bile duct with 100 mL of 0.9% sodium chloride injection after choledocholithotomy to observe if it can improve the clearance rate of residual stones.Methods A study enrolled patients receiving endoscopic retrograde cholangiopancreatography (ERCP) and mechanical lithotripsy for calculus of common bile duct ( ≥ 12 mm) were conducted. After occlusion cholangiography confirmed common bile duct stone clearance, intraductal ultrasonography (IDUS) was performed to determine clearance scores based on the number of residual stones. The amounts of residual stones spotted via IDUS were graded, a large amount of stone fragments scored 1, a small amount of stone fragments scored 2, completely cleared common bile duct without any biliary sludge scored 3. After clearing calculus of common bile duct in ERCP and rinsing with 50 mL and 100 mL 0.9% sodium chloride injection, IDUS examination was performed and scored.Results No patient had common bile duct clearance scores of reached 3 without saline irrigation, 45 (40.18%) patients reached 3 with 50 mL 0.9% sodium chloride injection irrigation, and 99 (88.39%) patients reached 3 with 100 mL irrigation. Multivariate Logistic regression analysis showed that common bile duct diameter > 15 mm [odds ratio (OR＾) = 4.90, 95% confidence interval (CI): 1.19 ~ 22.57, P = 0.013], angulation of the distal common bile duct (the angle between the axis of the common bile duct and the ampulla axis of the common bile duct in cholangiography) ≤ 140°(OR＾ = 6.92, 95%CI: 1.83 ~ 38.98, P = 0.047) and duodenal diverticulum (OR＾ = 4.10, 95%CI: 1.14 ~ 16.90, P = 0.041) were independent risk factors for failure to rinse with 100 mL 0.9% sodium chloride injection.Conclusion Irrigation with 100 mL 0.9% sodium chloride injection can effectively remove the residual calculus of common bile duct after lithotripsy.