χ螺旋水刀与钬激光治疗肝内胆管结石的比较

Helix hydro-jet compared with the holmium laser lithotripsy in the treatment of intrahepatic bile duct stones

目的 探讨螺旋水刀与钬激光碎石治疗肝内胆管结石的临床疗效和安全性.方法 158例肝内胆管结石患者随机分为螺旋水刀试验组（82例）和钬激光对照组（76例）,观察碎石时间、碎石次数、残石率、术后结石复发率、术中出血、术中冲洗水量、术中镇痛、术后出血、术后发热等指标.结果 2组患者在碎石次数、残石率、术后结石复发率比较,差异无统计学意义（P＞0.05）;水刀组和激光组在术中冲洗水量[（2300±275） ml比2 850±331）ml,P=0.002]、碎石时间（54.2±15.3） min比（38.1 ±12.7） min（χ^2=1.748,P=0.041）、术中出血（19例比29例,χ^2=4.189,P=0.041）、术中镇痛（2例比9例,χ^2=5.384,P=0.032）、术后出血（11例比21例,χ^2=4.936,P=0.037）、术后发热等并发症（30例比62例P =0.027）,2组指标比较,差异有统计学意义（P＜0.05）.结论 螺旋水刀与钬激光碎石治疗肝内胆管结石都是安全、有效的方法,钬激光碎石效率更高,螺旋水刀碎石更安全.

Objective To evaluate the curative effect,safety,advantages and disadvantages of helix hydro-jet and holmium laser lithotripsy in the treatment of intrahepatic bile duct stones.Methods 158 patients of intrahepatic bile duct stones were divided into helix hydro-jet group （n =82） and helix hydro-jet group （n =76）.Time of lithotripsy,frequencies of lithotripsy,residual stone,intraoperative hemorrhage,postoperative hemorrhage,stone recurrence rate,postoperative fever,and therapeutic efficacy were compared between the two groups.Results There was no significant difference between the two groups on frequency of lithotripsy,residual stone rate and stone recurrence rate （P ＞ 0.05） ; whereas intraoperative washing normal saline （2 300 ± 275） ml vs （2 850 ± 331） ml,（P =0.002）,the time of lithotripsy （54.2 ± 15.3） min vs （38.1 ± 12.7） min,P =0.041,intraoperative hemorrhage （19 cases vs 29 cases,P =0.041）,Intraoperative analgesia （2 cases vs 9 cases,P =0.032）,postoperative hemorrhage （11 cases vs 21 cases,P =0.037）,and postoperative fever （30 cases vs 62 cases,P =0.027） had significant differences（P ＜ 0.05）.Conclusions Both helix hydro-jet and the holmium laser lithotripsy is safe and effective for the treatment of intrahepatic bile duct stones.Holmium laser is more efficient than Helix Hydro-jet,while helix hydro-jet is safer than holmium laser in lithotripsy.