胆道镜联合钬激光碎石治疗肝内外胆管难取性残留结石

目的探讨经胆道镜钬激光碎石治疗肝内、外胆管难取性残留结石的实用性及安全性。方法观察18例胆道术后肝内、外胆管难取性残留结石患者接受胆道镜下钬激光碎石治疗的临床效果，并进行随访。结果经1～4次胆道镜下钬激光碎石治疗，18例患者残石全部取尽，未出现近期并发症。16例获得随访，随访时间6个月-1年，无结石复发和钬激光碎石相关的胆管狭窄出现。结论经胆道镜钬激光碎石是治疗肝内、外胆管难取性残留结石的一种安全、有效的方法。     

经胆道镜钬激光碎石治疗肝内外胆管难取性结石

目的探讨经胆道镜联合钬激光碎石治疗肝内外胆管难取性结石的价值。方法纤维胆道镜窥视下用钬激光碎石治疗肝内外胆管难取性结石29例,观察临床效果。结果经1～3次胆道镜下钬激光碎石治疗,28例患者结石全部取尽,1例未完全取净,成功率为96.55%（28/29）;近期无胆道出血、漏胆、黄疸等并发症发生。26例获得随访,随访时间6～20个月,平均13个月,未发现结石复发及胆管狭窄。结论经胆道镜钬激光碎石是一种治疗肝内外胆管难取性结石简便、安全及有效的方法。     

胆道镜下钬激光碎石治疗肝内外胆管难取性结石

目的探讨胆道镜下钬激光碎石技术在治疗肝内、外胆管难取性结石的可行性、安全性及应用价值。方法自2008年1月至2010年1月共收集36例肝内外难取性结石患者(术中32例,术后残余胆道结石4例),经术中胆总管切口或术后T管窦道置入胆道镜,当结石嵌顿或巨大而在取石网无法取出时,采用钬激光碎石后再以网篮取出。结果 36例经胆道镜下钬激光碎石结石全部取净(在胆道镜所及范围内),碎石时间1～5min,碎石次数1～4次。碎石过程中无胆管壁灼伤、出血及胆道穿孔。所有病例随访6～30个月,平均12个月,无结石残留或复发,无胆道狭窄发生。结论对于肝内、外胆管难取性结石,胆道镜下钬激光是一种简单、安全、有效的方法。     

胆道镜联合钬激光治疗肝内外胆管难取性结石

目的探讨胆道镜联合钬激光碎石治疗肝内、外胆管难取性结石的价值及安全性。方法21例肝内外难取性结石（初次手术15例,术后残余胆道结石6例）,经术中胆总管切口或术后T管窦道置入胆道镜联合钬激光（美国Coherent公司）碎石治疗,激光波长2.1μm,最大平均输出功率100W,脉冲峰值功率6kW,脉冲宽度0.25μs,光导纤维直径400μm。结果20例经胆道镜下钬激光碎石结石全部取净,碎石时间3～8min,碎石次数1～3次;1例经3次碎石,取出1枚结石,1枚结石位于肝内Ⅲ级肝管碎石未成功,结石未取出。碎石总数52枚,结石排净率95.2%（20/21）。术中无胆管壁灼伤及胆道穿孔。18例随访6～20个月,平均10个月,未发现结石复发及残留,无胆道狭窄。结论胆道镜联合钬激光是治疗肝内、外胆管难取性结石的一种简便、安全、有效的方法。     

胆胰镜下钬激光碎石术治疗术后难取性胆管结石

目的探讨胆胰镜下钬激光碎石治疗术后难取性胆管结石的价值。方法选取39例胆道镜难以取出的肝内胆管结石和3例胆道镜处理失败的肝外胆管结石患者,在胆胰镜下行钬激光碎石术,钬激光输出功率1.5~3.0 J,脉冲频率5~10 Hz。结果 39例行胆胰镜下钬激光碎石术2~6次,平均2.3次;36例取净结石,结石取净率92.3%(36/39);4例胆道镜处理失败的胆道结石行胆胰镜下钬激光碎石术1次予以取净。结论对于术后难取性胆管结石,胆胰镜下钬激光碎石术是安全、有效的新方法。     

胆道镜联合钬激光经T管窦道治疗肝内外胆管残余结石

目的:探讨胆道镜联合钬激光经T管窦道碎石治疗肝内、外胆管残余结石的临床价值和安全性。方法:回顾性分析2010年2月—2011年6月经术后T管窦道置入胆道镜联合钬激光碎石治疗300例肝内、外胆管残余结石患者的临床资料。结果:292例经胆道镜下钬激光碎石治疗结石全部取净,碎石时间4~12 min,碎石次数1~5次,13例经5次碎石;8例患者结石位于III,IV级肝管碎石未成功,带管2个月后经等离子体冲击波碎石,6例患者成功取出结石,2例患者结石未取出。碎石总数568枚,结石排净率97.3%(292/300)。术中无胆道大出血、穿孔、胆管壁灼伤、胆瘘等严重并发症发生;15例术后出现低热。268例随访6~18个月,平均10个月,未发现结石复发及残留,无胆道狭窄。结论:胆道镜联合钬激光碎石可显著提高肝内、外胆管残余结石的治疗效果,是一种简便、安全、有效的方法,值得临床应用推广。     

胆道镜配合钬激光术中治疗难取性胆管结石的临床应用体会

目的探讨胆道开放手术中经胆道镜配合钬激光治疗难取性肝内胆管结石的方法、疗效及安全性。方法 56例难取性肝内胆管结石采取经胆道镜配合钬激光碎石治疗。结果 53例一次性完全清除;3例碎石未能一次性完全清除结石,需再用切肝或胆管切开取石。一次性清除率为94.6%。全组病例未发生胆道损伤出血、胆漏、感染等并发症。结论术中胆道镜配合钬激光碎石是治疗肝内胆管难取性结石的一种安全、有效的技术。     

钬激光联合纤维胆道镜在难取肝内外胆管结石中的应用

目的探讨钬激光碎石联合胆道镜在难取肝内外胆管结石中应用的安全性和疗效。方法 2010年3月至2013年6月应用激光碎石联合胆道镜治疗22例难取肝内外胆管结石,在直视下接触结石,将结石击碎后注水冲出,或用取石篮套出。结果 22例结石,18例一次性完全清除,3例2次碎石,取尽,1例大部结石取除,小分支胆管有结石残留,本组无胆道损伤、出血。结论钬激光碎石联合胆道镜取石治疗难取性肝内外胆管结石具有直观、准确、方便、疗效确切的特点,是治疗难取肝内外胆管结石的一种安全、有效的新手段。     

胆道镜联合钬激光碎石治疗术后难取性肝内胆管结石

目的探讨胆道镜联合钬激光碎石治疗术后肝内胆管难取性结石的价值。方法2010年7月～2012年7月,采用纤维胆道镜下用钬激光碎石治疗术后肝内胆管难取性结石（嵌顿结石或结石〉1em）37例,功率0．8—1．2J／5～10Hz。结果37例行钬激光碎石1～12次,平均2．6次。1例因结石位于四级胆管,胆道镜无法进入,未完全取净,36例结石全部取净,成功率为97．3％（36／37）,碎石过程中无胆管壁灼伤、胆道穿孔。36例结石取净者术后随访3～25个月,平均12．3月,B超复查未发现结石复发。结论对于术后肝内胆管难取性结石,胆道镜下钬激光碎石是一种安全、有效的方法。     

胆道镜下钬激光联合液电碎石治疗肝内外胆道难治性结石

目的 探讨经胆道镜用钬激光联合液电碎石治疗肝内外胆道结石的安全性及疗效.方法 对67例胆道术后肝内外胆管结石患者接受胆道镜下钬激光联合液电碎石治疗患者的临床资料进行回顾性分析.结果 经1～7次胆道镜下钬激光联合液电碎石治疗,65例患者残石全部取尽,碎石取石成功率达97.1%,未出现并发症.结论 通过钬激光联合液电碎石后再行胆道镜取石,可大大提高肝内外胆管残留结石的清除效果,是一种安全而有效的治疗方法 .     

219例肝内胆管结石的外科治疗

目的:总结并评价肝内胆管结石的外科手术治疗效果。方法:单纯胆道探查T管引流72例,肝叶(段)切除和胆肠内引流109例,胆总管切开并胆道镜钬激光碎石术取石 T管引流38例。结果:总治疗优良率83.8%,并发症率15.1%,死亡率0.5%,结石残石率14.1%。胆总管切开合并胆道镜碎石术应用者明显优于其他组。结论:充分利用先进的诊疗技术,选择合理的术式,保留Oddi括约肌功能,可有效提高治疗效果,降低并发症及残石率。     

钬激光碎石术与气压弹道碎石术治疗胆道术后残余结石临床比较

目的比较钬激光碎石术与气压弹道碎石术治疗胆道术后残余结石的临床疗效。方法使用钬激光碎石治疗85例胆道术后残余结石患者;气压弹道碎石术治疗85例胆道术后残余结石患者。结果85例使用钬激光碎石治疗的患者一次手术结石粉碎率为96.4%,平均手术时间为25min。而气压弹道碎石组中上述各项指标分别为78.8%;平均手术时间为49min,均与钬激光碎石组有明显差异。结论钬激光碎石效明显优于气压弹道碎石,是治疗胆道术后残余结石一种安全、有效的碎石方法。     

钬激光碎石术在胆道结石中的临床应用(附17例报告)

目的 探讨镇激光碎石术治疗胆道结石的疗效及安全性。方法 纤维胆道镜直视下用钬激光碎石治疗肝内胆管结石和胆道术后残余结石17例。结果 17例经T管造影及术中胆道造影证实共有36枚结石。不用钬激光直接取出7枚结石；经钬激光碎石取出24枚结石，成功率82．8％(24／29)；余5枚结石在3级胆管以上，胆道镜无法直接观察到，未作钬激光治疗。术后1月B超及胆道造影未见肝外胆道内残余结石，未作治疗的肝内胆管结石仍在原位。全部病例无胆道出血、胆漏、肝功能损害等并发症。T管拔除后随访半年，总胆管内未发现残余结石，无胆管扩张及胆管炎征象，肝功能检查无异常。结论 在纤维胆道镜直视下用钬激光碎石治疗肝内胆管结石和胆道术后残余结石，结石清除率可达82．8％，有效、安全。     

Holmium: YAG laser lithotripsy for gallstones. A preliminary report

BACKGROUND: Most retained gallstones can be extracted at the time of operative exploration or endoscopic retrograde cholangiopancreatography (ERCP). Infrequently, impaction or associated anatomic abnormalities may prevent their clearance. We assessed the efficacy of the holmium:YAG laser in managing retained biliary calculi that had proven refractory to the usual methods of extraction. METHODS: Two patients with calculi impacted in the intrapancreatic common bile duct and one patient with residual stones in a nonfunctional gallbladder were treated with holmium:YAG laser lithotripsy. Two of these patients were treated under conscious sedation, and one received a general endotracheal anesthetic. Laser energy was delivered by a 272-mm optical fiber inserted through a 7-Fr fiberoptic endoscope. The ablative effects were monitored continuously via videoscopic. RESULTS: All of the stones were cleared successfully in a single therapeutic setting. In one patient, fragments of the impacted intraductal stone were extracted with an endoscopic wire basket. In the other two patients, stone debris was completely cleared with saline irrigation. No complications developed, and all patients remained free of recurrence during a 6-month follow-up period. CONCLUSIONS: The holmium:YAG laser is a multidisciplinary instrument that is safe and effective in the fragmentation of both urinary and biliary calculi. Because it can be delivered through a small-caliber fiberoptic endoscope, it should be particularly useful to laparoscopic surgeons who manage complicated biliary tract disease.     

双频激光碎石在腔镜外科难取性胆管结石中的应用(附23例报告)

目的探讨双频激光碎石治疗腔镜外科难取性胆管结石的疗效及安全性. 方法 2002年1月～2004年6月,对23例难取性胆管结石进行双频激光碎石治疗.其中腹腔镜胆道探查术中应用14例,术后胆道镜取石中应用9例. 结果 19例取净胆管中结石,结石取净率为82.6%(19/23),无胆管损伤、窦道损伤等并发症. 结论双频激光碎石具有创伤小、效率高、并发症少的优点,对腔镜外科难取性胆管结石是一种可选择的有效方法.     

腹腔镜下钬激光碎石术治疗难取性肝胆管结石

目的探讨腹腔镜下钬激光碎石术在难取性肝胆管结石治疗中的临床应用价值。方法观察腹腔镜下胆总管切开应用钬激光碎石术治疗22例肝胆管难取性结石的临床疗效及并发症。结果22例均碎石、取石成功,无死亡病例。探查后胆总管一期缝合3例,T管引流19例,术中经胆囊管操作成功2例,平均术后住院时间6.8d。结论腹腔镜下钬激光碎石术治疗难取肝胆管性结石创伤小,恢复快,碎石充分,结石取净率高。为肝胆管难取性结石治疗开辟了一条新的治疗途径。     

Indication and procedure for treatment of hepatolithiasis

HYPOTHESIS: Because of its complicated clinicopathologic features, hepatolithiasis is difficult to treat, and there is no established method of treating patients with intrahepatic stones. DESIGN: Retrospective case-control study. SETTING: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan (January 1, 1971-December 31, 2000). PATIENTS: Eighty-nine patients treated for hepatolithiasis (43 male; median age, 56.9 years). MAIN OUTCOME MEASURES: The rate of residual stones and complications after the treatments of hepatolithiasis. RESULTS: Between 1971 and 1985, 17 patients (41%) had stones located in the left or right intrahepatic duct, and 25 patients (60%) had stones located in the bilateral intrahepatic duct. From 1986 through 2000, 32 patients (68%) had stones located in the left or right intrahepatic duct, and 15 patients (32%) had stones located in the bilateral intrahepatic duct (P =.009). The rate of residual stones after surgical and nonsurgical treatment was 41% (17 of 42 patients) in 1971 through 1985, but decreased to 11% (5 of 47 patients) in 1986 through 2000 (P =.001). The rate of residual stones after cholangioenterostomy or T-tube insertion was 43.8% (21 of 48 patients), but the rate of residual stones after hepatectomy or percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) was 2.4% (1 of 41 patients, P<.001). In cases treated by PTCSL, we used a holmium (Ho):YAG laser in 3 cases since 1999. To our knowledge, there have been no reports describing the use of Ho:YAG lasers to treat hepatolithiasis. Also, board-shaped stones can be sufficiently pulverized without inducing hemorrhage from the bile duct wall. CONCLUSIONS: According to the current therapeutic strategy for hepatolithiasis, hepatectomy seems to be the most effective treatment for selected patients with isolated left hepatolithiasis if other surgical procedures cannot remove all the related lesions. In addition, PTCSL seems to be performed first in isolated right hepatolithiasis and bilateral lobe type hepatolithiasis. In PTCSL procedures, favorable results have been obtained using the Ho:YAG laser for fracturing intrahepatic stones.