Percutaneous Management of Extrahepatic Bile Duct Stones by Papillary Balloon Dilation and Pushing Using an Occlusion Balloon

經皮利用氣球擴張乳頭部以及使用阻塞氣球將結石推入十二指腸來處理肝外膽管結石

吳仁宏(Reng-Hong Wu) ； 陳炯毓(Matt Chiung-Yu Chen) ； 張世欽(Shih-Chin Chang) ； 曾文盛(Wen-Sheng Tzeng) ； 方瑞隆(Je-Lung Fung)

《中華放射線醫學雜誌》 33卷3期 (2008/09) Pp. 115-122

摘要

描述藉由經皮的方式利用氣球擴張乳頭部以及使用阻塞氣球將結石推入十二指腸來處理肝外膽管結石。
從民國九十五年五月到九十六年十一月總共有十六例病患藉由經皮的方式來處理肝外膽管結石，其中十三例病患經由穿肝的路徑、一例經由T形造瘻管、一例經由膽囊管引流路徑以及一例經由穿肝膽囊引流管路徑。此技術主要分為兩大步驟：一為使用血管成形術之氣球擴張乳頭部；其次為使用阻塞氣球順勢將結石推入十二指腸。
結石大小平均為9±2.4毫米，每位病患的結石數目平均為1.4±0.9顆。14例病患之結石有成功移除，其中12例僅需施行一次手術；另外兩例則施行了兩次手術。手術失敗的原因包含擴張的低位膽囊管以及無法忍受手術的疼痛。術後總共有七例發生上腹痛的症狀，但其症狀皆在兩天內緩解。並沒有明顯的出血或是急性胰臟炎的發生。
經皮利用氣球擴張乳頭部以及使用阻塞氣球推石術為一簡單、有效且安全的手術，可以用來處理肝外膽管結石的病患。

並列摘要

To report our experience of percutaneous elimination of extrahepatic bile duct stones by occlusion balloon pushing after papillary balloon dilation.
Between May 2006 and November 2007, sixteen patients were treated percutaneously for extrahepatic bile duct stones. Thirteen patients were treated via transhepatic route, one patient via T-tube route, one patient via transcystic duct drainage route, and one patient via transhepatic gallbladder drainage route. The procedure had two main steps. The first step was dilation of the papilla of common bile duct by an angioplasty balloon, and the second step was antegradely pushing the stones into duodenum using an occlusion balloon.
The diameter of extrahepatic bile duct stone was 9±2.4 mm. The number of stone was 1.4±0.9. Successful stone removal was achieved in 14 patients (87.5%). Twelve patients required one session for complete stone clearance and two patients required two sessions. Technical failure was noted in two patients. The reasons for failure were dilated lower inserted cystic duct in one patient and intolerable pain during dilation and pushing in the other patient. Seven patients felt epigastric pain after the procedure, which subsided within two days. There was no significant procedure related bleeding or clinical symptoms of acute pancreatitis.
The percutaneous papillary balloon dilation and stone-push is a simple, effective and safe technique for treatment of patient with extrahepatic bile duct stones.