腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗胆总管结石

目的探讨腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗胆总管下段嵌顿结石的价值及安全性。方法选取温州医科大学附属第二医院2014年7月1日至2016年6月30日收治的25例胆囊结石合并胆总管下段嵌顿结石的患者,施行经胆囊管钬激光碎石术治疗。钬激光输出功率1.0~2.0 J,脉冲频率5~10 Hz,在直视下接触结石,将结石击碎后通过取石网篮套取出结石。结果 25例行经胆囊管钬激光碎石术治疗后胆总管下段嵌顿结石均能取石成功,结石1次取净,圈套器结扎胆囊管根部,未行T管引流。手术时间(139.30±30.10)min;术中出血量(83.60±40.10)mL,术后住院时间(4.20±0.65)d。随访6~24个月,无胆道狭窄,无胆漏等发生,结石复发率4%(1/25)。结论对于胆囊管4 mm、继发性胆总管结石患者来说,腹腔镜联合胆道镜经胆囊管钬激光碎石术是一种有效、安全的治疗方法。

Laparoscopy combined choledochofiberscopy transcystic holmium laser lithotripsy in the treat-ment of common bile duct stones: a report of 25 cases

Objective To study the clinical value of laparoscopy combined choledochofiberscopy transcys-tic holmium laser lithotripsy in the treatment of common bile duct (CBD). Methods Between Jul.12014 and Jun. 302016, 25 patients diagnosed as CBD stones were treated with transcystic holmium laser lithotripsy. The generator was initially set at 1.0~2.0 J and 5~10 Hz. Then the calculi was removed after smashed. Results It was successfully performed in all the 25 patients. The transcystic holmium laser lithotripsy could eliminate CBD stones completely and it was unnecessary to plant a T-tube. The average operating duration was (139.30±30.10) min, the mean bleeding volume was (83.60±40.10) mL and the postoperative hospitalization was (4.20±0.65) d. There was no postoperative complication, such as biliary stricture or bile leakage. The stone recurrence rate was 4% (1/25). Conclusion For the patient whose cystic duct is more than 4 mm, laparoscopic transcystic holmium laser lithotripsy is an effective and safe treatment for the CBD stones.