钬激光在胆总管下段嵌顿结石术中的应用

The Application of Holmium Laser for Operation in Common Bile Duct Incarceration Stones

目的探讨钬激光在胆总管下段嵌顿性结石手术中的应用价值。方法通过腹腔镜下胆道镜工作通道,应用钬激光,功率为0.6-0.8J/10Hz,直径为200um光导纤维,在直视下接触结石,将嵌顿结石击碎后注水冲出,或用取石篮套出。结果11例均取石碎石成功,手术时间75-205min,平均95.5min,出血80-130ml,平均89.4ml。平均住院8.2d。术后无胆道出血,胆漏。术后2W照影无结石残留,胆总管下段通畅无胆道狭窄。术后肝功能2W恢复正常6例,5例1月均恢复正常。随访3-6月未见结石复发。结论钬激光治疗胆总管下段嵌顿结石,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 for operation in common bile duct incarceration stones. Methods under choledochoscope with laparoscope ,200um fibre Holmium laser diameter of common bile duct incarceration stones was performed ,the settings on the laser were 0.6 -0.8J/10Hz, the stones fragmented and then extracted with irrigation or by using a basket. Results the stones were successfully removed in all 1 lcases, operation times 75 - 205min（ average 95.5min）, to bleed 80 - 130ml（ average 89.4ml） ,averrage in hospital 8.2d. No bile duct bleeding or biliry leakage occurred after operdtion. No stones remained to photograph 2w after operdtion, the segment inferior of common bile duct was easy and smooth. 2w after operdtion, 6 cases Hepatic function was to recovered ,5 cases recovered with 1 month, follow -up 3 -6 months , all cases without stone to recur. Conclusion KIN and electronic -film in clinical medicine have better valve in improving quality and efficiency of doctors＇ work.