两镜联合钬激光治疗复杂性胆道结石

Laparoscopy combined with choledochoscopy and holmium laser in the treatment of complicated biliary calculi

目的：探讨腹腔镜下钬激光通过胆道镜通道治疗复杂性胆道结石的临床价值。方法：回顾分析2009年3月至2013年12月为23例复杂性胆道结石患者行两镜联合钬激光碎石术的临床资料,其中19例术前确定行钬激光碎石术,4例因两镜取石困难改行钬激光碎石,采用200μm光导纤维,功率为1.5 J/10 Hz,每次激发点射间隔1 s以上,直视下碎石,击碎后注水冲出或取石篮取出。结果：患者无一例中转开腹,手术时间平均（92.5±23.1）min,碎石时间平均（32.6±15.5）min,碎石时激光点射5～10次,共碎石46枚,术后平均住院（8.5±2.0）d,结石残留2例,发生全身炎症反应综合征3例,胆道出血1例,无胆漏、腹腔脓肿,21例随访3～6个月,未见胆道狭窄。结论：两镜联合钬激光治疗复杂性胆道结石具有患者创伤小、碎石操作直观、安全有效等特点,为复杂性胆道结石的治疗提供了新途径。

Objective： To investigate the clinical value of laparoscopy combined with choledochoscopy and holmium laser in the treatment of complicated biliary calculi. Methods： Retrospective analysis was made on clinical data of 23 patients with complicated biliary calculi who underwent laparoscopy combined with choledochoscopy and holmium laser between Mar. 2009 and Dec. 2013. 19 cases planned to use holmium laser before operation,4 cases underwent this operation because of difficult laparoscopic and choledochoscopic lithotomy. 200 μm optical fibre was used with power of 1. 5J /10Hz and interval more than 1 s under direct observation. The stones were fragmented and extracted by irrigating or using a basket. Results： There was no conversion to laparotomy. The operation time was（ 92. 5 ± 23. 1） min,lithotripsy time was（ 32. 6 ± 15. 5） min,laser was aroused 5-10 times when lithotripsy. 46 stones were fragmented.Postoperative hospital stay was（ 8. 5 ± 2. 0） d. 2 cases of stone residue,3 cases of systemic inflammatory response syndrome,1 case of biliary tract bleeding occurred,and there were no bile leakage or abdominal abscess. 21 cases were followed up for 3 to 6 months without biliary stricture. Conclusions： Laparoscopy combined with choledochoscopy and holmium laser in the treatment of complicated biliary calculi are safe and effective with mini-invasion and direct observation,provide an alternative method for the treatment of complicated biliary calculi.