体内冲击波碎石在治疗复杂肝胆管结石中的应用评价

Evaluation of shock-wave Lithotripsy in vivo for the Treatment of Complicated-hepatolithiasis

目的探讨体内冲击波碎石治疗复杂肝胆管结石的临床意义。方法收集联合应用体内冲击波碎石治疗的肝胆管结石患者116例,分为2组,即开腹手术联合体内冲击波碎石治疗组103例,经T管窦道胆道镜冲击波碎石治疗组13例,并以开展碎石术前收治的110例肝胆管结石患者为对照组。回顾性分析3组的临床资料,比较开腹手术联合体内冲击波碎石治疗组与对照组的住院时间、手术时间、残石率及并发症发生率情况。结果开腹手术联合体内冲击波碎石组与对照组在住院时间、手术时间方面差别无统计学意义(P>0.05),但前者可显著降低术后残余结石率(P<0.05)。经T管窦道行胆道镜下冲击波碎石、取石的13例患者,一次取净结石12例,一次取净率92.3%(12/13)。联合应用冲击波碎石治疗肝胆管结石不会增加胆道出血、发热等并发症的发生率(P>0.05)。结论联合应用体内冲击波碎石治疗复杂肝胆管结石可显著减低术后残余结石率;为治疗难取的右肝内胆管结石,巨大、铸形及嵌顿等复杂的肝胆管结石提供了一种有效、可行的新途径,治愈率高、并发症少、疗效确切,值得临床推广使用。

Objective To evaluate the clinical application of shock-wave lithotripsy in vivo for the treatment of complicated-hepatolithiasis.Methods A total of 116 patients with hepatolithiasis treated by shock-wave lithotripsy in vivo through choledochscopy were enrolled in the study and divided into 2 groups： one group included 103 cases treated by shock-wave lithotripsy in vivo;the other,13 cases treated with shockwave lithotripsy in vivo through T-tube.Another 110 patients with hepatolithiasis treated by laparotomy only（without shock-wave lithotripsy）were treated as the control group.A retrospective analysis was carried out among the 3 groups.The control group and the group treated by shock-wave lithotripsy in vivo were compared in terms of the length of hospital stay,operative time,the incidence of residual stones and complications.Results The comparison between the group treated by shock-wave lithotripsy in vivo and the control group showed no difference in the length of hospital stay and operative time（P〉0.05）,but significant difference in the incidence of residual stones（P〈0.05）.The stones in 12 of the 13 treated with shockwave lithotripsy in vivo through T-tube were entirely removed in one session,with the rate of 92.3%（12/13）.The treatment of hepatolithiasis by shock-wave lithotripsy in vivo did not increase the incidence of complications such as the biliary tract bleeding or fever（P〉0.05）.Conclusion Combined treatment with shock-wave lithotripsy in vivo for hepatolithiasis can remarkably reduce the incidence of retained calculus after operation,which proves an effective and feasible way for treating complicated-right-hepatic bile duct stones,large,cast-shaped,incarcerated and other refractory bile duct stones.It＇s outstanding features such as high cure rate,fewer complications,remarkable healing effect,make it valuable in clinic application.