经T管窦道硬镜联合钬激光碎石术治疗肝内外胆管残余结石的临 床研究

【摘要】目的:探讨在鞘管保护下经T管窦道采用硬镜联合钬激光治疗肝内外胆道残余结石的临床价值。方法:2015年8 月~2018年8月，将62例肝内外胆管残余结石病人，随机将分为硬镜组和纤维胆道镜组（软镜组），各31例，硬镜组在鞘管 保护下经T管窦道采用硬镜联合钬激光碎石取石治疗，软镜组则经T管窦道采用纤维胆道镜联合钬激光碎石取石，分析 比较两组手术时间、术后住院时间、结石取净率，以及相关主要并发症。结果:硬镜组结石取净率优于软镜组（90.3% vs 64.5%, P=0.033），硬镜组手术时间少于软镜组（63±58 min vs 130±44 min, P<0.01）；两组术后住院时间、并发症发生率等 比较无统计学差异（P>0.05）。结论:对于术后肝内外胆管残余结石，采用经T管窦道硬镜联合钬激光进行碎石取石是安 全、可行、高效的，手术时间短，术后恢复快，是治疗胆道外科术后残余结石可优选的微创治疗策略。

Clinical study on the treatment of residual intrahepatic and extrahepatic bile duct stones via T-tube sinus tract by rigid choledochoscope combined with holmium laser lithotripsy

Abstract: Objective To investigate the clinical value of rigid choledochoscope combined with holmium laser lithotripsy in the treatment of residual intrahepatic and extrahepatic bile duct stones through T-tube sinus tract under sheath protection. Methods FromAugust 2015 to August 2018, 62 patients with residual intrahepatic and extrahepatic bile duct stones were randomly divided into rigid choledochoscope group and choledochofiberscope group, with 31 cases in each group. The patients in rigid choledochoscope group were treated with rigid choledochoscope combined with holmium laser lithotripsy through T-tube sinus tract under the protection of sheath tube, while those in choledochofiberscope group were treated with fiberoptic choledochoscope combined with holmium laser lithotripsy through T-tube sinus tract. The operation time, postoperative hospital stay, stone clearance rate and related major complications of two groups were analyzed and compared. Results Compared with choledochofiberscope group, rigid choledochoscope group had a higher clearance rate (90.3% vs 64.5%, P=0.033) and a shorter operation time ［(63±58) min vs (130±44) min, P<0.01］. There was no significant difference in postoperative hospital stay and incidence of complications between two groups (P>0.05). Conclusion Using rigid choledochoscope combined with Holmium laser lithotripsy through T-tube sinus tract for the treatment of residual intrahepatic and extrahepatic bile duct stones is proved to be safe, feasible and efficient, with the advantages of short operation time and rapid recovery. Rigid choledochoscope combined with Holmium laser lithotripsy through T-tube sinus tract is an optimal minimally invasive treatment strategy for residual bile duct stones after biliary surgery.