术中超声联合胆道镜治疗肝内胆管结石的临床意义

The treatment of intrahepatic bile duct stones with fiber choledochoscope combined with intraoperative ultrasound

目的探讨术中超声(IOUS)联合纤维胆道镜在治疗肝内胆管结石中的临床意义。方法回顾分析185例肝内胆管结石患者的临床资料。其中术中、术后应用胆道镜取石(下称胆道镜组)96例和IOUS联合纤维胆道镜取石(下称联合组)89例,比较两组疗效。结果胆道镜组残石率(9.38%)高于联合组(2.08%)(P=0.041);结石复发率(12.34%)也高于联合组(3.61%)(P=0.036);两组胆管炎发生率差异无统计学意义(P=0.087),胆道镜组3例重型胆管炎需再次手术治疗。结论在治疗肝内胆管结石中,采用术中超声联合纤维胆道镜能降低残石率及结石复发率。

Objective To investigate the clinical significance of the treatment of intrahepatie bile duct stones with fiber eholedoehoscope combined with intraoperative ultrasound. Methods The clinical data of 185 cases with intrahepatic bile duct stone were analysed retrospectively, included 96 cases with stone removal by fiber choledochoscope intra-and post-operatively （ choledoehoscope group ） , and 89 cases with stone removal by fiber choledoehascope combined with intraoperative ultrasound （ combined group ）. Results The rateo of bile duct retained stones in choledochoseope group （9.38 % ） was higher than that in combined group （2.08%） （P =0. 041 ） , and the rate of bile duct recurrent stones in eholedochoscope group （12.34%） was higher than that in combined group （3.61%）（ P =0. 036）. There was no significant differences between the two groups in the occarrence of eholangitis （ P = 0. 087 ） , but 3 eases of severe cholangitis required re-operation in eholedochoseope group. Conclusions Fiber eholedochoseope combined with intraoperative ultrasound can decrease the rate of bile duct retained stones and bile duct recurrent stones, and can improve the therapeutic effect.