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目的探讨肝内外胆管多发性结石、巨大结石、壶腹部嵌顿性结石、小乳头及乳头旁憩室切开禁忌者、T管引流术后残余结石ERCP困难者等难取性胆管结石内镜治疗。方法分别采用术中、术后胆道镜、EST后机械碎石、胆道子母镜、鼻胆／胆肠引流等方法。结果 149例难取性胆管结石中。术中胆道镜取净率95％(19／20),术后经T管胆道镜取净率(35／40)87．5％,机械碎石率94．7％,(72／76),肝外胆管结石取净率94．6％(122／129)。结论应用内镜下综合治疗难取性胆管结石大大提高了结石取净率、减少了残石率。达到去除病灶、通畅引流,值得推广。
Objective To investigate endoscopic refractory choledocholithiasis such as multiple intrahepatic bile duct stones, huge stones, ampulla incarcerated stones, small nipples and papillary diverticular incisions, contralateral residual stones after T-tube drainage. Methods The intraoperative, postoperative choledochoscope, EST after mechanical gravel, cholecystectomy, nasal bile duct / gallbladder drainage and other methods. Results 149 cases of bile duct stones. The rate of intraoperative choledochoscopy was 95% (19/20), the rate of choledochoscopy (87.5%), the rate of mechanical gravel (94.7%, 72/76) Extrahepatic bile duct stone removal rate was 94.6% (122/129). Conclusion The application of endoscopic comprehensive treatment of refractory bile duct stones greatly increased the rate of stone removal, reducing the residual stone rate. To remove the lesion, smooth drainage, it is worth promoting.