探讨日间胆道镜取石在胆道手术后残余结石患者治疗中的安全性和疗效。

回顾性分析2018年10月至2019年9月在西安交通大学第一附属医院收治的118例胆道术后残余结石患者临床资料。其中男45例，女73例；平均年龄（59±14）岁。首次开腹手术80例，腔镜手术26例，经皮经肝胆道镜术12例。患者均签署知情同意书，符合医学伦理学规定。患者入院24 h内完成入院、胆道镜取石及出院。分析日间胆道镜治疗患者手术及术后并发症发生情况。

日间胆道镜取石均于原胆道手术后6～12周实施。行胆道镜取石共162例次，其中1次性结石取净率79.7%（94/118），2次结石取净率为11.9%（14/118），取石3次及以上者8.5%（10/118）。单纯采用网篮取石90例，先碎石再取石27例，球囊扩张后再取石1例。整体日间手术完成率达98.8%（160/162）。2例术后出现急性胆管炎，积极治疗后痊愈，无发生胆道出血和窦道损伤。

日间胆道镜治疗胆道术后残余结石疗效确切，安全性高，患者住院周期短，可纳入日间手术流程。

To explore the safety and efficacy of day-case choledochoscopy in the treatment of patients with residual calculi after biliary tract surgery.

Clinical data of 118 patients with residual calculi after biliary tract surgery admitted in the First Affiliated Hospital of Xi'an Jiaotong University from October 2018 to September 2019 were retrospectively analyzed. Among them, 45 patients were male and 73 female, with a mean age of (59±14) years. For the primary surgery, 80 cases underwent open surgery, 26 cases laparoscopic surgery and 12 cases percutaneous transhepatic choledochoscopy. The informed consents of all patients were obtained and the local ethical committee approval was received. The patients were admitted in hospital and underwent choledochoscopy and then discharged within 24 h. Operations and postoperative complications of the patients undergoing day-case choledochoscopy were analyzed.

Day-case choledochoscopy was performed in the patients 6 to 12 weeks after the primary bile duct surgery. 162 times of choledochoscopic lithotripsy were performed, with once-through stone removal rate 79.7% (94/118), twice stone removal rate 11.9% (14/118) and ≥ 3 times stone removal rate 8.5% (10/118). Basket extraction was performed in 90 cases, extraction after lithotripsy was performed in 27 cases and extraction after balloon expansion was used in 1 case. The overall completion rate of day-case surgery reached 98.8% (160/162). 2 cases suffered from acute cholangitis after operation and recovered after active treatments. No biliary bleeding and sinus injury occurred.

Day-case choledochoscopy in treating residual calculi after biliary tract surgery is effective, safe. It can be incorporated into the day-case surgeries for a short hospitalization period.