胆道镜联合钬激光碎石治疗术后难取性肝内胆管结石

Holmium Laser Lithotripsy Combined with Choledochoscope for Postoperative Refractory Stone in the Intrahepatic Bile Duct

目的探讨胆道镜联合钬激光碎石治疗术后肝内胆管难取性结石的价值。方法 2010年7月～2012年7月,采用纤维胆道镜下用钬激光碎石治疗术后肝内胆管难取性结石(嵌顿结石或结石>1 cm)37例,功率0.8～1.2 J/5～10Hz。结果 37例行钬激光碎石1～12次,平均2.6次。1例因结石位于四级胆管,胆道镜无法进入,未完全取净,36例结石全部取净,成功率为97.3%(36/37),碎石过程中无胆管壁灼伤、胆道穿孔。36例结石取净者术后随访3～25个月,平均12.3月,B超复查未发现结石复发。结论对于术后肝内胆管难取性结石,胆道镜下钬激光碎石是一种安全、有效的方法。

Objective To discuss the value of holmium laser lithotripsy combined with choledochoscope for the treatment of postoperative refractory stone in the intrahepatic bile duct. Methods The clinical data of 37 patients with postoperative refractory stone in the intrahepatic bile duct, who received holmium laser lithotripsy （0.8 - 1.2 J/5 - 10 Hz） combined with choledochoscope from June 2010 to June 2012 were reviewed retrospectively. Results The patients totally received 1 - 12 times of holmium laser lithotripsy in each, with a mean of 2.6 times. In one patient the stones were not removed completely by choledochoscopy. The other 36 patients were cured by the treatment with the stones being removed completely. The success rate of the procedure was 97. 3% （36/37）. No bile duct wall burns or perforation occurred during the procedure. The 36 patients, whose stones were removed completely, were followed up for 3 to 25 months with a mean of 12.3 months, during which re-examination by B-uhrasonography revealed no recurrent stones. Conclusion Holmium laser lithotripsy combined with choledochoscopy is safe and effective for choice for postoperative refractory stone in the intrahepatic bile duct.