输尿管镜气压弹道碎石技术在肝胆管结石中的应用体会

目的探讨一种新技术即用输尿管镜气压弹道碎石技术治疗肝胆管结石的疗效。方法回顾性分析2010年1月-2014年10月36例术中采用输尿管镜气压弹道碎石治疗肝胆管结石病患者的资料。结果胆总管结石肝总管结石一次性取净结石率100%（12/12）。二级以上肝胆管结石一次性取净结石率66.7%（24/36）。结石残余术后采用经T管瘘道输尿管镜＋气压弹道碎石取石12例,33.3%（12/36）。肝内结石碎石后结石下移,阻塞肝外胆管2例5.56%（2/36）,术中配合胆道镜网篮取石3例8.33%（3/36）,切口感染4例11.1%（4/36）,胆瘘、腹腔局限性腹膜炎2例5.56%（2/36）,无胆道狭窄、穿孔、出血。结论采用输尿管镜气压弹道碎石治疗肝胆管结石具有操作简单、取石快、残石率低、并发症少、费用低等优点,为临床提供了一种治疗肝胆结石的新方法,有推广应用价值。

Application of ureteroscopic pneumatic ballistic lithotripsy technology in the treatment of hepatolithiasis

Objective The aim of the study is to explore the method and effect of ureteroscopic pneumatic lithotripsy for treatment of hepatolithiasis during operation. Methods 36 hepatolithiasis patients, in the laparotomy or laparoscopic operation, the ureteroscopic pneumatic lithotripsy was used for lithotripsy of various hepatolithiasis, flushing with hydraulic pump or clamping out of stone with pliers. Results The onetime calculi free rate of common bile duct and common hepatic duct reached 100% （ 12/12）, the second level hepatolithiasis reached 66. 7% （24/36）. Using ureteroscopic, the residual stones cases can be performed pneumatic lithotripsy under direct vision to remove again through ＂T＂ tube after the operation 33.3% （12/36）. 2 cases intrahepatic stones moved to extrahepatic bile duct 5.56% （2/36）, 3 cases used choledochoscopic stone basket 8.33% （3/36）, wound infection in 4 cases 11. 1% （4/36）, 2 biliary fistula, abdominal limitations of peritonitis 5.56% （2/36）, no biliary fistula, no gastrointestinal bleeding, and no death. Conclusion Ureteroscopic pneumatic ballistic lithotripsy technology is a new method for the treatment of hepatolithiasis, with high efficiency, low residual stone rate, operation safety, simple operation and other advantages, which is worthy of clinical application.