Experiences of Electrohydraulic Lithotripsy for Difficult Common Bile Duct Stones

以水電氣碎石術治療困難總膽管結石的經驗

楊昌學(Chang-Shyue Yang) ； 王秀伯(Hsiu-Po Wang) ； 王世晞(His-Hshi Wang) ； 林俊哲(Chun-Che Lin) ； 吳明賢(Ming-Shiang Wu) ； 林肇堂(Jaw-Town Lin)

《中華民國消化系醫學雜誌》 18卷2期 (2001/06) Pp. 114-118

https://doi.org/10.6557/GJTb.200106_18(2).0001

摘要

較大的總膽管結石即使在內視鏡乳突切開術合併氣球或取石籃取石術後仍常無法被取出。通常可使用機械式碎石器來攪碎結石，但有時會遇到石頭太硬或卡在總膽管而無法被攪碎。本研究利用十二指腸鏡施行水電氣碎石術於16位患者。他們均有較大之總膽管結石，經過內視鏡乳突切開術合併氣球或取石籃取石術無法取出結石且機械式碎石器無法攪碎結石。水電氣碎石術分別經由一般使用的逆行性膽胰攝影之注射管，取石用之氣球導管或子母鏡施行，八位患者的結石完全被攪碎，六位患者的結石部份被攪碎，由於總膽管的彎角過大，導致有二位失敗。其失敗率為12.5% (2/16)。十六位患者中均無併發症或死亡發生。對於困難或卡住的總膽管結石，水電氣碎石術是一種有效的輔助治療方法。

關鍵字

水電氣碎石術 ； 總膽管結石

並列摘要

Large common bile duct (CBD) stones may be difficult to be extracted through basket or balloon catheter after endoscopic sphincterotomy. Sometimes, these stones can be crushed by mechanical lithotripsy. But stones may be too hard or impacted in CBD. We have utilized electrohydraulic lithotripsy (EHL) via duodenoscope for the treatment of difficult CBD stones in 16 patients. All had large retained CBD stones which were refractory to endoscopic sphinterotomy with basket or balloon extraction and incapable to be fragmented by mechanical lithotripsy. EHL was applied trans-papillarily through simple cannula, balloon catheter, or mother-baby endoscope. Stones were completely crushed in 8 patients and partially in 6 patients. We failed to crush stones in 2 patients because of sharp angulation of CBD in them. The failure rate was 12.5% (2/16). No complication and no mortality were found in these 16 patients. We concluded that EHL is a useful adjuvant therapy for removal of difficult and impacted stones in CBD.

並列關鍵字

electrohydraulic lithotripsy ； common bile duct stone