硬质胆镜与纤维胆道镜治疗胆管结石的临床优势比较

目的:探讨硬质胆镜与纤维胆道镜在腹腔镜胆总管探查术中治疗胆管结石的应用价值。方法:将86例确诊的胆管结石患者随机分为硬质胆镜组和纤维胆道镜组2组,分别行腹腔镜联合硬质胆镜和纤维胆道镜胆总管探查治疗,比较2组患者不同胆管部位的探查成功率、取石率、残石率及巨大嵌顿结石的取出率。结果:2组患者探查成功率差异无统计学意义(P0.05)。硬质胆镜组和纤维胆道镜组I期取石率分别为69.8%和58.1%,总取石率分别为90.7%和83.7%,残石率分别为9.3%和11.6%,差异均无统计学意义(P0.05)。硬质胆镜组和纤维胆道镜组肝内胆管巨大嵌顿石取出率分别为85.7%和45.5%,硬质胆镜组高于纤维胆道镜组(χ2=4.588,P=0.032);胆总管下段巨大嵌顿石取出率分别为90.9%和61.5%,硬质胆管镜组高于纤维胆道镜组,但差异无统计学意义(χ2=2.967,P=0.085);肝脏边缘结石取出率分别为33.3%和50.0%,纤维胆道镜组高于硬质胆镜组,差异亦无统计学意义(χ2=0.486,P=0.486)。结论:纤维胆道镜和硬质胆镜在治疗胆管结石中各有不同的优势,临床应用中2种胆道镜合理配合应用有助于提高取石成功率。

Comparision of clinical advantages of rigid choledochoscope and choledochofiberscope for the treatment of biliary calculi

Objective：To explore the clinical advantages of rigid choledochoscope and choledochofiberscope in laparoscopic common bile duct exploration for patients with biliary calculi.Methods：Totally 86 cases of biliary calculi were randomly divided into the rigid choledochoscope group and choledochofiberscope group,the exploration success rate,extraction rate of bile duct stone,residual stone rate and extraction rate of huge incarcerated stones were compared between two groups.Results：The exploration success rate of rigid choledochoscope group and choledochofiberscope group showed no statistically significant difference（P＞0.05）,and the extraction rates of bile duct stone in rigid choledochoscope group and choledochofiberscope group were 69.8％ and 58.1％ respectively; total stone extraction rate were 90.7％ and 83.7％ respectively; residual stone rate was 9.3％ and 11.6％ respectively,the differences were no statistics significance（P＞0.05）.the extraction rate of huge incarcerated stones in intrahepatic bile duct respectively were 85.7％ and 45.5％,the rigid choledochoscope group was higher than the choledochofiberscope group （x2=4.588,P=0.032）,the extraction rate of huge incarcerated stones in distal common bile duct were 90.9％ and 61.5％,the rigid choledochoscope group was higher than the choledochofiberscope group,but the difference was not statistically significant （x 2=2.967,P=0.085）,the removal rate of stone in liver edge were 33.3％ and 50.0％,respectively,the choledochofiberscope group higher than rigid choledochoscope group,bur the difference was not statistically significant （x2=0.486,P=0.486）.Conclusion：Choledochofiberscope and rigid choledochoscope have the different advantages in the treatment of biliary calculi,reasonable application of two choledochoscope can help to improve the rate of successfully extraction of biliary calculi.