Mechanical Lithotripsy in the Treatment of Common Bile Duct Stones

機械式碎石術治療總膽管結石症

劉振華(Jenn-Hwa Liu) ； 陳儉鏗(Gran-Hum Chen) ； 胡必雄(Bin-Hsiung Hu) ； 周偉強(Wai-Keung Chow) ； 葉宏仁(Hong-Jen Yeh) ； 潘廣勤(Kwong-Kan Poon) ； 張繼森(Chi-Sen Chang) ； 黃志仁(Chi-Ren Huang)

《中華民國消化系醫學會雜誌》 9卷4期 (1992/12) Pp. 266-271

https://doi.org/10.6557/GJTa.199212_9(4).0002

摘要

總膽管結石症病例有百分之八十以上可經壺腹乳切開術以氣球及抓籃清除。但直徑二公分以上結石仍有困難。機械式碎石術適用於(1)結石直徑大於乳頭切開直徑者，(2)總瞻管末端狹小彎曲者，(3)壺腹括約肌切開較狹小者，如有出血頃向或憩室內乳頭患者。
台中榮民總醫院胃腸科應用奧林柏斯公司機械式碎石器BML-IQ，BML-2Q，BML-3Q，治療35例總膽管結石症，石頭直徑1.2-4公分，平均2.3±0.5公分，其中18例經1次治療，11例經2次治療，6例經3次治療，其中29例成功取出結石，6例失敗，成功率82.8%。失敗的原因為多發性結石佔據總膽管全部空間，且結石太硬，抓籃無法張開抓住並絞碎結石者有4例，因總膽管末端狹窄呈S型彎曲故抓籃無法張開抓住石頭者有2例。失敗者皆接受體外震波碎石術治療，4例成功經內視鏡取出結石，2例因總瞻管末端狹窄彎曲仍無法取出結石，以膽道膺管置放術治療。
我們建議總膽管結石症經內視鏡壺腹括約肌切開術以傳統氣球及抓籃仍無法清除結石者，適用機械式碎石術為優先治療選擇。如結石大於2.5公分，也可直接選用機械式碎石術治療。

關鍵字

機械式碎石術 ； 體外震波碎石術 ； 內視鏡壺腹括約肌切開術

並列摘要

Mechanical lithotripsy was used to treat 35 cases of common bile duct lithiasis after failure of an initial trial with a conventional balloon catheter and Dormia basket, or attempted directly when the stones' diameter were larger than 2.5 cm. Stone sizes ranged from 1.2 to 4 cm with a mean of 2.3±0.5cm. The overall success rate was 29/35 (82.8%) after 1-3 procedures. No serious complications occurred. The causes of failure included inability to entrap stones due to multiple large stones that impacted almost the entire diameter of the common bile duct in 4 cases, and stones located above a tortuously contricted duct in another 2 cases. All failed cases underwent extra corporeal shock wave lithotripsy, and stones were successfully removed by endoscopic extraction in 4 cases. Biliary stent was placed in the remaining 2 cases after extracorporeal shock wave lithotripsy but also failed to clear the stone by conventional methods. We recommend mechanical lithotripsy as the first choice in the treatment of choledocholithiasis after failure of an initial trial with conventional Dormia basket, or as a direct attempt to clear a very large stone (＞2.5cm).

並列關鍵字

mechanical lithotripsy ； extracorporeal shock wave lithotripsy ； endoscopic sphincterotomy