纤维胆道镜、术中B超、螺旋水刀综合治疗肝内外胆管结石的价值

Treatment ofintrahepatic biliary calculi with choledochoscope combined with in traoperative ultra sound and Helix Hydro-Jet

目的评估术中纤维胆道镜、超声、螺旋水刀综合治疗肝内外胆管结石中的价值。方法收集2004年1月到2008年12月211例肝内外胆管结石患者临床资料,按不同的手术方法分为3组:Ⅰ组术中纤维胆道镜取石70例,Ⅱ组术中B超、纤维胆道镜取石68例,Ⅲ组术中B超、纤维胆道镜、螺旋水刀联合取石73例,比较3组的疗效。结果Ⅰ、Ⅱ、Ⅲ组的残石率分别是21.43%、8.82%、4.11%,结石复发率分别是31.43%、16.18%、5.48%,胆管炎发生率分别是14.29%、11.76%、2.74%。结论纤维胆道镜、术中超声、螺旋水刀联合治疗肝内胆管结石能降低残石率、结石复发率和胆管炎发生率,同时能明确术前未能确诊的病变,有利于术中正确选择手术方式。

Objective To evaluate the clinical significance of the treatment ofintrahepatic biliary calculi with choledochoscope combined with in traoperative ultra sound and Helix Hydro-Jet. Methods The clinical data of 211 cases with intrahepatic biliary calculi from January 2004 to December 2008 were collected and analyzed, including groupⅠ, 70 cases with stone removal by choledochoscope; groupⅡ,68 cases with stone removal by choledochoscope combined with intraoperative ultrasound; group Ⅲ, 73 cases with stone removal by choledochoscope combined with intraoperative ultrasound and Helix Hydro-Jet. Results The calculi residue rate were 21.43%, 8.82%, 4.11% in group Ⅰ, Ⅱ, Ⅲ, respectively. Calculi recurrent rate were 31.43%, 16.18%, 5.48%, respectively. The rateo of occarrence of cholangitis were 14.29%, 11.76%, 2.74%. Conclusion Choledochoscope combined with intraoperative ultrasound and Helix Hydro-Jet can decrease calculi residue rate, calculi recurrent and rateo of occarrence of cholangitis, and may improve the therapeutic effect.