欧远祥

[摘要] 目的 探究输尿管硬镜下气压弹道碎石与胆道镜下液电碎石术治疗肝内外胆管结石的临床疗效及安全性。 方法 选取我院2013年5月～2015年5月收治的复杂性肝内外胆管结石患者共82例，按照随机数表法将其随机分为对照组（n=40）与观察组（n=42）。对照组接受胆道镜下液电碎石术治疗，观察组接受输尿管硬镜下气压弹道碎石术治疗。比较两组患者手术一般情况，结石取净率及并发症情况。 结果 观察组手术操作时间及取石时间明显短于对照组（t=5.9922，6.5804，P<0.05）。观察组术后结石取净率为71.4%，明显高于对照组的47.5%（χ2=4.8781，P<0.05）。观察组术后并发症发生率为4.8%，明显低于对照组的25.0%（χ2=6.7171，P<0.05）。 结论 输尿管硬镜下气压弹道碎石治疗肝内外胆管结石具有较好的临床效果，术后结石取净率较高，安全可靠，值得临床推广应用。

[关键词] 输尿管硬镜下气压弹道碎石；胆道镜下液电碎石；肝内外胆管结石

[中图分类号] R657.4+2 [文献标识码] A [文章编号] 1674-4721（2016）02（b）-0038-03

Feasibility and safety study on ureteroscopic air-pressure ballistic lithotripsy in the treatment of intra- and extra-hepatic bile duct calculus

OU Yuan-xiang

The Second Department of Surgery，Dongfeng People′s Hospital of Zhongshan City in Guangdong Province，Zhongshan 528425，China

[Abstract] Objective To explore the clinical effect and safety of ureteroscopic air-pressure ballistic lithotripsy and choledochoscopic electrohydraulic lithotripsy in treatment of intra-and extra-hepatic bile duct calculus. Methods 82 patients with complicated intra-and extra-hepatic bile duct calculus treated in our hospital from May 2013 to May 2015 were selected and randomly divided into the control group（n=40） and the observation group（n=42）.Patients in the control group were treated by choledochoscopic electrohydraulic lithotripsy，while patients in the observation group were treated by ureteroscopic air-pressure ballistic lithotripsy.The general condition，total removal rate of calculus，and complications of two groups were compared. Results The time of operation and calculus removal in the observation group was significantly shorter than that of the control group respectively（t=5.9922，6.5804，P<0.05）.The total removal rate in the observation group was 71.4%，significantly higher than 47.5% in the control group （χ2=4.8781，P<0.05）.The incidence rate of complication in the observation group was 4.8%，which was significantly lower than 25.0% in the control group（χ2=6.7171，P<0.05）. Conclusion The clinical effect of ureteroscopic air-pressure ballistic lithotripsy is favorable in treatment of intra-and extra-hepatic bile duct calculus，with high total removal rate of calculus and high safety，which is worthy to be promoted.

[Key words] Ureteroscopic air-pressure ballistic lithotripsy；Choledochoscopic electrohydraulic lithotripsy；Intra-and extra-hepatic bile duct calculus

胆石症是我国常见的疾病之一，发病率为0.9%～10.0%[1]，按照结石所在部位不同，可分为肝内胆管结石与肝外胆管结石及胆囊结石[2]。目前临床治疗胆结石主要依靠外科手术治疗，如胆囊切除联合胆管切开取石，但传统外科手术具有结石残余率高、术后易复发等特点[3-4]。近年来微创外科得到不断发展，输尿管硬镜下气压弹道碎石、胆道镜液电碎石、超声碎石等具有较好的结石清除效果，同时创伤性小、较直观，可有效应对复杂性肝内外胆管结石[5]。本研究观察输尿管硬镜下气压弹道碎石治疗肝内外胆管结石，取得了较好的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

选取我院2013年5月～2015年5月收治的肝内外胆管结石患者共82例，所有患者均依据临床病史、超声及CT、MRCP等影像学资料等确诊为胆结石[6]。将所有患者按照随机数表法分为对照组与观察组。……