摘要
目的探讨应用钬激光联合硬质镜碎石治疗肝内复杂性胆管结石的手术方法、疗效安全性,与传统方法治疗比较针对难取性残留结石的优越性。方法肝内复杂性胆管结石患者行胆总管切开,术中使用钬激光联合硬质镜将结石击碎后注水冲出。肝内复杂性胆管结石患者44例分为两组,其中钬激光联合硬质镜碎石取石试验组23例,传统手术方法配合纤维胆道镜术中取石对照组21例。结果 (1)试验组中结石完全取净23例(100%),平均手术时间为2.1h,平均住院时间9.5d,术后胆道损伤出血1例;(2)对照组结石完全取净11例(52.38%),平均手术时间2.7h,平均住院时间11.3d,术后感染4例,肝功能损害2例,术后残余结石再经T管窦道胆道镜取石10例。钬激光联合硬质镜碎石23例均一次性完全清除胆管结石,近期无感染、胆漏、肝功能损害等并发症。随访半年,腹部B超等检查未发现结石残留、胆道狭窄。两组在结石取净率、平均手术时间、平均术中失血量、平均住院时间、术后并发症的比较差异有统计学意义(P<0.05),而平均卧床时间比较差异无统计学意义(P>0.05)。试验组的疗效显著优于对照组。结论钬激光联合硬质镜治疗肝内复杂性胆管结石,具有创伤小、恢复快、操作容易、碎石彻底、并发症少等优点。钬激光联合硬质镜碎石是目前治疗肝内复杂性胆管结石方法中较安全、经济、有效的方法。
Objective To explore the application of holmium laser lithotripsy combined rigid endoscopy in the treatment of complicated intrahepatic bile duct stones in surgical methods,efficacy safety,compared with the conventional treatment for the superiority of refractory residual stone.Methods Intrahepatic bile duct stones were treated by the choledochotomy,the intraoperative use of holmium laser combined with rigid endoscopy made the stone affused out after the stone was crushed.Forty-four patients of intrahepatic complicated bile duct stones divided into two groups,in which experimental group of holmium laser lithotripsy combined with rigid endoscopy had 23 patients and in which control group of conventional surgical methods applying choledochofiberscope had 21 patients.Results (1) Stones completely removed in the experimental group 23 cases (100%),the mean operative time was 2.1 hours and the average hospital stay was 9.5 days,1 case of postoperative hemorrhage of bile duct injury;(2)stones completely removed in the control group 11 cases (52.38%),the mean operative time was 2.7 hours,the average hospital stay was 11.3 days,4 cases of postoperative infection,2 cases of liver injury,10 cases of postoperative residual stones and then through T tube sinus by choledochofiberscope.The 23 cases' bile duct stones of holmium laser lithotripsy combined rigid endoscopy once cleared completely,no recent infection,no bile leakage,no liver damage and other complications.Six months follow-up,the examination for example abdominal B-type ultrasound found no residual stones or bile duct stenosis.There was statistically significant difference (P〉0.05) in the stone clearance rate,the average operation time,average blood loss,length of stay,postoperative complications between each other,while the average time in bed was no statistically significant difference (P〈0.05).The efficacy of the experimental group was significantly better than the control group.Conclusion Holmium laser lithotripsy combined rigid end
出处
《中外医学研究》
2011年第34期1-4,共4页
CHINESE AND FOREIGN MEDICAL RESEARCH
基金
湖南省科技厅基金项目资助(项目编号:2009FJ3184)
关键词
钬激光
硬质镜
纤维胆道镜
胆管结石
Holmium laser
Rigid endoscopy
Choledochofiberscope
Bile duct stones