腹腔镜、胆道镜联合微爆破碎石仪治疗难取性胆总管结石的临床分析

目的:探讨腹腔镜胆总管探查术中采用胆道镜下微爆破碎石术治疗难取性胆总管结石的安全性及临床疗效。方法:回顾分析2014年1月至2018年10月施行腹腔镜胆总管探查术中应用纤维胆道镜联合iMES-I型体内微爆破碎石仪治疗73例难取性胆总管结石患者的临床资料。观察分析碎石成功率、结石取净率及并发症发生率。结果:73例腹腔镜手术均成功完成,无一例死亡。碎石成功率100%,手术时间50~143 min,平均(72±21)min;术中出血量30~100 mL,平均(55±21)mL。术后胆道残石2例,结石取净率97.3%,无胆漏、出血、胆道感染等并发症发生。住院6~10 d,平均(6.3±1.4)d。随访3月~半年,未发生胆道相关并发症。结论:掌握一定的手术技巧,腹腔镜胆总管探查术中应用胆道镜联合微爆破碎石仪治疗难取性胆总管结石是安全、易行、有效的,具有较好的临床应用价值。

Clinical analysis of laparoscopy,choledochoscopy and shockwave lithotripsy for refractory choledocholithiasis

Objective:To investigate the efficacy and safety of laparoscopic and choledochoscopic technique combined with type shockwave lithotripsy for refractory choledocholithiasis.Methods:A retrospective analysis was performed on the clinical data of 73 patients with refractory choledocholithiasis who were treated by laparoscopic common bile duct exploration and choledochoscopic technique combined with iMES-I shockwave lithotripsy between Jan.2014 and Oct.2018.The successful rates of lithotripsy,calculi clearance rates and complication incidences were observed and discussed.Results:The operation was successfully performed in all 73 cases without deaths.The successful rates of lithotripsy was 100%,the duration of operation was(72±21)min(range 50-143),and the blood loss in operation was(55±21)mL(range 30-100).Residual biliary calculi were found in 2 cases,the clearance rate was 97.3%,and there were no bile leakage,bleeding,biliary tract infection.Hospital stay was(6.3±1.4)d(range 6-10).Follow-up checkups in all for 3 months to half a year revealed no biliary-related complications.Conclusions:With certain surgical techniques and positive perioperative treatment,laparoscopy,choledochoscopy and shockwave lithotripsy for refractory biliary lithiasis is safe,feasible and effective and has preferable clinical application value.