钬激光联合胆道镜治疗胆总管结石

Holmium laser combined with choledochoscopy for the treatment of common bile duct stones

目的探讨钬激光联合胆道镜在治疗复杂性胆总管结石中的价值。方法通过胆道镜工作通道，应用钬激光，功率为1．0J／10Hz，直径为200μm光导纤维，在直视下接触结石，将胆总管结石击碎后注水冲出，或用取石篮套出。结果17例均取石成功，取石时间10—50min，平均20min。探查后胆总管一期缝合8例，T管引流6例，经窦道取石3例，术后无胆道出血，胆漏。16例随访6—15个月，平均10个月，腹部B超或磁共振胆胰管造影（magnetic resonance cholangiopancreatography，MRCP）检查，未发现结石复发及残留，无胆道狭窄。结论钬激光联合胆道镜治疗复杂性胆总管结石，具有创伤小、恢复快、碎石确切、操作容易、安全有效等优点，为治疗复杂性胆总管结石开辟了一条新的治疗途径。

Objective To discuss the value of holmium laser lithotripsy combined with choledochoscopy in the treatment of complicated common bile duct stones. Methods Under eholedochoscopy, 200μm fibre holmium laser lithotripsy of common bile duct stones was performed. The settings on the laser were 1.0 J and 10 Hz. The choledochoscope was used to access the common bile duct stones. The stones were fragmented and then extracted with irrigation or by using a basket. Results The stones were successfully removed in all the 17 cases. The duration of operation was 10 -50 min （mean, 20 min）. Out of the 17 cases, there were 8 cases of primary closure of the common bile duct, 6 cases of T - tube drainage, and 3 cases of stone removal via drainage passage. No bile duct bleeding or biliary leakage occurred after operation. Follow - up was conducted in 16 cases for 6 - 15 months （ mean, 10 months）. B -uhrasonography or magnetic resonance cholangiopancreatography found no recurrent or residual stones, or bile duct stricture. Conclusions Holmium laser lithotripsy combined with choledochoscopy in the treatment of complicated common bile duct stones has advantages of minimal invasion, rapid recovery, satisfactory lithotripsy effects, simplicity of performance, and high reliability.