廖广宇

【摘要】 目的：分析膽道镜联合钬激光碎石治疗肝内外胆管难取性结石的效果。方法：将2015年1月-2016年1月在笔者所在医院就诊的98例肝内外胆管难取性结石患者按照数字随机表法分为对照组和试验组；对照组在胆道镜引导下行液电碎石治疗，试验组在胆道镜引导下行激光碎石治疗；对比分析两组患者手术过程、碎石率、术后并发症等。结果：试验组患者术中出血量（16.5±7.0）ml、手术时间（29.1±8.9）min及住院时间（4.6±2.3）d，均显著小于对照组，差异有统计学意义（P<0.05）。两组患者碎石成功率、结石取净率和再次手术率比较差异无统计学意义（P>0.05）。对照组患者术后并发症发生率（12.24%），显著高于试验组（2.04%），差异有统计学意义（P<0.05）；对照组术后1年复发率（6.12%）与试验组（4.08%）比较差异无统计学意义（P>0.05）。结论：在胆道镜引导下，液电碎石技术与钬激光碎石技术均获得了较优的治疗效果，但钬激光碎石技术创伤小、恢复快、并发症发生风险低，具有推广应用价值。

【关键词】 肝内外胆管难取性结石； 胆道镜； 钬激光碎石； 液电碎石

doi：10.14033/j.cnki.cfmr.2017.29.003 文献标识码 A 文章编号 1674-6805（2017）29-0005-03

Treatment of Intrahepatic and Extrahepatic Bile Duct Stones with Choledochoscopy Combined with Holmium Laser and Electro-hydraulic Lithotripsy/LIAO Guang-yu.//Chinese and Foreign Medical Research，2017，15（29）：5-7

【Abstract】 Objective：To analyze the application of choledochoscopy combined with holmium laser lithotripsy in the treatment of intrahepatic and extrahepatic bile duct refractory stones.Method：From January 2015 to January 2016，98 cases of intrahepatic and extrahepatic bile duct refractory stones were randomly divided into the control group and the experimental group according to the random number method.The control group was treated with choledochoscopy.The experimental group was treated with laser lithotripsy under the guidance of choledochoscopy.The operative procedure，gravel rate and postoperative complications were analyzed.Result：The intraoperative blood loss （16.5±7.0）ml，operation time （29.1±8.9）min and hospital stay （4.6±2.3）d in the experimental group，which were significantly lower than those in the control group（P<0.05）.There was no significant difference in gravitational success rate，stone removal rate and reoperation rate between the two groups（P>0.05）.The incidence of postoperative complications in the control group（12.24%） was significantly higher than that in the experimental group（2.04%），the difference was significant（P<0.05）；the recurrence rate in the control group（6.12%） was not significant than 4.08% in the experimental group（P>0.05）.Conclusion：Under the guidance of choledochoscopy，fluidized lithotripsy and holmium laser lithotripsy have obtained better therapeutic effect，but holmium laser lithotripsy is less traumatic，quick recovery，low risk of complications，and has popular application value.

【Key words】 Intrahepatic and extrahepatic bile duct refractory stones； Choledochoscopy； Holmium laser lithotripsy； Electro-hydraulic lithotripsyendprint

First-authors address：Longyan Peoples Hospital，Longyan 364000，China

最近十几年来，钬激光技术得到了快速的发展，其在肝内外胆管结石中的应用越来越广泛，这为结石的临床治疗提供了新的方法；尤其是在大结石、结石嵌顿或者是合并胆道狭窄等肝内外胆管难取性结石中的应用[1-2]。胆道镜联合钬激光碎石治疗肝内外胆管难取性结石时，胆道镜引导钬激光进行碎石处理，将大结石或者嵌顿结石击碎，让其直径缩小，这有助于取出小碎石[3-4]。这项联合技术具有取石率较高，对患者胆道损伤小，术后并发症较少，安全性较高等优势[5-6]。本文对从2015年

1月-2016年1月在笔者所在医院就诊的肝内外胆管难取性结石患者为研究对象，除术中碎石外，笔者所在医院已开展纯腔镜下胆总管切开取石术取得了良好效果。……