Percutaneous transhepatic papillary balloon dilation as a therapeutic option for choledocholithiasis.
Percutaneous transhepatic papillary balloon dilation as a therapeutic option for choledocholithiasis.
复制标题
经皮肝穿刺乳头状球囊扩张术作为胆总管结石的治疗选择。
DOI：
10.1007/s00534-003-0851-x
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
K. Okinaga
中科院分区：
文献类型：
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作者：
I. Nagashima;T. Takada;Masatoshi Shiratori;T. Inaba;K. Okinaga
对于胆总管结石，目前标准的治疗方法包括内窥镜括约肌切开术(EST)或内窥镜乳头气囊扩张术(EPBD)。然而，由于解剖异常的原因，内窥镜治疗的过程非常复杂，有时甚至不完整。因此，我们在一年前开始对一些选定的患者进行经皮经肝乳头状气囊扩张术(PTPBD)而不是内窥镜治疗胆总管结石。方法超声引导下经皮肝穿胆管引流术(PTCD)。通过引流途径插入球囊导管，直到到达胆总管。然后，进行胆道造影术，识别结石。气囊在Vater乳头处充气4毫升，维持3分钟。接下来，用同样的球囊导管将结石快速推入十二指肠。如果结石直径大于8 mm，则在球囊扩张前进行篮式碎石。所有患者均成功地将胆管结石推入十二指肠。由于技术问题，前三名患者需要两次疗程才能完成结石清除；然而，后两名患者只需要一次疗程。无死亡病例，无并发症。结论PTPBD可能是胆总管结石的一种可行的替代治疗方案。
BackgroundFor choledocholithiasis, endoscopic therapy, including endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilation (EPBD), is now standard. However, the procedure of endoscopic therapy is very complicated and sometimes incomplete for reasons of anatomical anomalies. Therefore, we started performing percutaneous transhepatic papillary balloon dilations (PTPBD) instead of endoscopic therapy for choledocholithiasis 1 year ago for some selected patients. We report our technical methods of PTPBD.MethodsFirst, percutaneous transhepatic cholangiodrainage (PTCD) was performed under ultrasound guidance. Via the drainage route, the balloon catheter was inserted until the common bile duct was reached. Then, cholangiography was performed and the stones were identified. The balloon was maintained in the inflated state with 4 ml air at the papilla of Vater for 3 min. Next, the stones were pushed out rapidly into the duodenum with the same balloon catheter. If the stone diameter was larger than 8 mm, then basket lithotripsy was performed before balloon dilation.ResultsFive patients underwent PTPBDs. The bile duct stones were successfully pushed out into the duodenum in all patients. The first three patients required two sessions for complete stone clearance due to technical problems; however, the last two patients needed only one session. There were no deaths and no complications.ConclusionsWe recommend that PTPBD might be a feasible and alternative therapeutic option for choledocholithiasis.