胆道镜钬激光碎石术联合肝叶切除术治疗复杂性肝内胆管结石

目的 探讨胆道镜钬激光碎石术联合肝叶切除治疗复杂肝内胆管结石的临床效果。方法 回顾性分析2016年6月至2019年6月浙江中医药大学附属嘉兴市中医院42例利用胆道镜及钬激光碎石术联合肝叶切除术治疗复杂肝内胆管结石（联合治疗组）的患者临床资料，并与同期40例未使用钬激光碎石、仅使用胆道镜实施肝叶切除术的复杂肝内胆管结石（传统治疗组）的患者临床资料进行对比分析。结果 与传统治疗组相比，联合治疗组手术时间稍延长[（242.1±41.2）min vs（224.5±38.1）min，t=2.01，P=0.048]，但术后平均住院时间更短[（17.2±3.9）d vs （20.9±4.0）d，t=-4.287，P＜0.001]、住院费用更少[（3.45±0.47）万元 vs（3.66±0.47）万元，t=-2.077，P=0.041]。术后联合治疗组无胆道感染发生，结石复发率[1（2.38%）vs 9（22.50%）]、术后总并发症发生率[（2（4.76%）vs 21（52.50%）]均低于传统治疗组，差异具统计学意义（P＜0.05）。 结论 利用胆道镜钬激光碎石术联合肝叶切除术治疗复杂性肝内胆管结石，具有创伤小、恢复快、结石清除率高、术后并发症少等优点，效果良好，值得临床推广应用。

Choledochoscopic holmium laser lithotripsy combined with hepatectomy in the treatment of complicated hepatolithiasis

Objective To explore the clinical efficacy of choledochoscopic holmium laser lithotripsy combined with hepatectomy in treating complex hepatolithiasis. Methods Clinical data of 42 cases with hepatolithiasis from Jun. 2016 to Jun. 2019, who received choledochoscope holmium laser lithotripsy combined with hepatectomy (combination group) were retrospectively analyzed. The results were compared with those of 40 patients with complicated hepatolithiasis who only received choledochoscopy and hepatectomy (traditional group). Results Compared with the traditional group: the combination group had longer operation time [(242.1±41.2) min vs (224.5±38.1) min, t=2.01, P=0.048], shorter mean hospitalization duration [(17.2±3.9) d vs (20.9±4.0) d, t=-4.287, P<0.001], and less hospitalization costs [(3.45±0.47) ten thousand yuan vs (3.66± 0.47) ten thousand yuan, t=-2.077, P=0.041]. No biliary tract infection occurred in the combination group after operation, and the recurrence rate of stones [1(2.38%) vs 9(22.50%)] and total postoperative complications [2(4.76%) vs 21(52.50%)] were lower than those in traditional group. The difference was statistically significant, P<0.05. Conclusion Choledochoscopic holmium laser lithotripsy combined with hepatectomy in treating complicated hepatolithiasis has the advantages of less trauma, quicker recovery, higher stone clearance rate and less postoperative complications, which is worthy of clinical promotion.