膽道鏡聯(lián)合鈥激光與液電碎石治療肝內外膽管多發(fā)結石比較

廖廣宇

【摘要】 目的：分析膽道鏡聯(lián)合鈥激光碎石治療肝內外膽管難取性結石的效果。方法：將2015年1月-2016年1月在筆者所在醫(yī)院就診的98例肝內外膽管難取性結石患者按照數(shù)字隨機表法分為對照組和試驗組；對照組在膽道鏡引導下行液電碎石治療，試驗組在膽道鏡引導下行激光碎石治療；對比分析兩組患者手術過程、碎石率、術后并發(fā)癥等。結果：試驗組患者術中出血量（16.5±7.0）ml、手術時間（29.1±8.9）min及住院時間（4.6±2.3）d，均顯著小于對照組，差異有統(tǒng)計學意義（P<0.05）。兩組患者碎石成功率、結石取凈率和再次手術率比較差異無統(tǒng)計學意義（P>0.05）。對照組患者術后并發(fā)癥發(fā)生率（12.24%），顯著高于試驗組（2.04%），差異有統(tǒng)計學意義（P<0.05）；對照組術后1年復發(fā)率（6.12%）與試驗組（4.08%）比較差異無統(tǒng)計學意義（P>0.05）。結論：在膽道鏡引導下，液電碎石技術與鈥激光碎石技術均獲得了較優(yōu)的治療效果，但鈥激光碎石技術創(chuàng)傷小、恢復快、并發(fā)癥發(fā)生風險低，具有推廣應用價值。

【關鍵詞】 肝內外膽管難取性結石； 膽道鏡； 鈥激光碎石； 液電碎石

doi：10.14033/j.cnki.cfmr.2017.29.003 文獻標識碼 A 文章編號 1674-6805（2017）29-0005-03

Treatment of Intrahepatic and Extrahepatic Bile Duct Stones with Choledochoscopy Combined with Holmium Laser and Electro-hydraulic Lithotripsy/LIAO Guang-yu.//Chinese and Foreign Medical Research，2017，15（29）：5-7

【Abstract】 Objective：To analyze the application of choledochoscopy combined with holmium laser lithotripsy in the treatment of intrahepatic and extrahepatic bile duct refractory stones.Method：From January 2015 to January 2016，98 cases of intrahepatic and extrahepatic bile duct refractory stones were randomly divided into the control group and the experimental group according to the random number method.The control group was treated with choledochoscopy.The experimental group was treated with laser lithotripsy under the guidance of choledochoscopy.The operative procedure，gravel rate and postoperative complications were analyzed.Result：The intraoperative blood loss （16.5±7.0）ml，operation time （29.1±8.9）min and hospital stay （4.6±2.3）d in the experimental group，which were significantly lower than those in the control group（P<0.05）.There was no significant difference in gravitational success rate，stone removal rate and reoperation rate between the two groups（P>0.05）.The incidence of postoperative complications in the control group（12.24%） was significantly higher than that in the experimental group（2.04%），the difference was significant（P<0.05）；the recurrence rate in the control group（6.12%） was not significant than 4.08% in the experimental group（P>0.05）.Conclusion：Under the guidance of choledochoscopy，fluidized lithotripsy and holmium laser lithotripsy have obtained better therapeutic effect，but holmium laser lithotripsy is less traumatic，quick recovery，low risk of complications，and has popular application value.

【Key words】 Intrahepatic and extrahepatic bile duct refractory stones； Choledochoscopy； Holmium laser lithotripsy； Electro-hydraulic lithotripsyendprint

First-authors address：Longyan Peoples Hospital，Longyan 364000，China

最近十幾年來，鈥激光技術得到了快速的發(fā)展，其在肝內外膽管結石中的應用越來越廣泛，這為結石的臨床治療提供了新的方法；尤其是在大結石、結石嵌頓或者是合并膽道狹窄等肝內外膽管難取性結石中的應用[1-2]。膽道鏡聯(lián)合鈥激光碎石治療肝內外膽管難取性結石時，膽道鏡引導鈥激光進行碎石處理，將大結石或者嵌頓結石擊碎，讓其直徑縮小，這有助于取出小碎石[3-4]。這項聯(lián)合技術具有取石率較高，對患者膽道損傷小，術后并發(fā)癥較少，安全性較高等優(yōu)勢[5-6]。本文對從2015年

1月-2016年1月在筆者所在醫(yī)院就診的肝內外膽管難取性結石患者為研究對象，除術中碎石外，筆者所在醫(yī)院已開展純腔鏡下膽總管切開取石術取得了良好效果。……