胆道镜联合钬激光碎石治疗肝内胆管结石的临床体会

目的:探讨腹腔镜下胆道镜联合钬激光治疗肝内胆管结石的效果及临床价值。方法:回顾分析2008年6月至2012年6月124例胆道结石患者的临床资料,其中60例行腹腔镜下胆道镜联合钬激光碎石术(观察组),64例行传统开腹手术,术中配合胆道镜取石,未使用钬激光(对照组)。结果:观察组中58例(96.7%)结石完全取净,手术时间平均(98.93±10.66)min,平均住院(8.3±1.7)d,术后残余结石2例,经T管窦道胆道镜再次取石成功。对照组中38例(59.4%)取净结石,手术时间平均(122.8±13.43)min,平均住院(13.98±1.49)d;残余结石26例,术后经T管窦道胆道镜再次取石,其中6例经2次取石,3次、4次取石及再次开腹手术各2例。两组患者手术时间及住院时间差异有统计学意义(P<0.01),术后胆道出血、肝功能异常、腹水等并发症发生率差异无统计学意义(P>0.05)。结论:腹腔镜下胆道镜联合钬激光治疗肝内胆管结石具有患者创伤小、康复快、碎石确切、安全有效等优点,为治疗肝内胆管结石开辟了新的治疗途径。

The clinical research of choledochoscope and holmium laser in the treatment of intrahepatic biliary tract calculus

Objective:To investigate the therapeutic effect and clinical value of choledochoscope and holmium laser in the treatment of intrahepatic biliary tract calculus in laparoscopic operation.Methods:A retrospective analysis was made on the clinical data of 124 patients with biliary stones from Jun.2008 to Jun.2012,of which 60 patients were treated by choledochoscope and holmium laser lithotripsy in laparoscopy(observation group) and 64 cases underwent traditional open surgery with intraoperative choledochoscope(not using the holmium laser in the control group).Results:The calculi were completely removed in 58 cases in observation group(96.7%),the average operation time was(98.93±10.66) min,the average length of hospital stay was(8.3±1.7) d.Postoperative residual stones were found in two cases,and were successfully removed by choledochoscope through T-tube sinus again.All the stones were removed in 38 cases in control group(59.4%),the mean operative time was(122.8±13.43) min,average length of hospital stay was(13.98±1.49) d.Residual stones were found in 26 cases and were removed by choledochoscope through T-tube sinus again,in which 2 cases underwent twice stone removal,2 cases of calculi were removed for 3 times and 4 times respectively by choledochoscope through T tube sinus,and 2 cases underwent laparotomy.There were statistically significantly differences in the operative time and the length of hospital stay in the two groups(P<0.01).No significant difference was found in the incidence of complications such as postoperative biliary tract bleeding,liver dysfunction or ascites(P>0.05).Conclusions:It is safe and effective to treat intrahepatic calculus by choledochoscopy and holmium laser in laparoscopic operation with less trauma and quicker recovery.It offers a new treatment way to intrahepatic bile duct stones.