胆胰镜下钬激光碎石术治疗术后难取性胆管结石

Cholangiopancreatoscopic Holmium laser lithotripsy for the treatment of postoperative refractory bile duct stones

目的探讨胆胰镜下钬激光碎石治疗术后难取性胆管结石的价值。方法选取39例胆道镜难以取出的肝内胆管结石和3例胆道镜处理失败的肝外胆管结石患者,在胆胰镜下行钬激光碎石术,钬激光输出功率1.5-3.0 J,脉冲频率5-10 Hz。结果 39例行胆胰镜下钬激光碎石术2-6次,平均2.3次;36例取净结石,结石取净率92.3%（36/39）;4例胆道镜处理失败的胆道结石行胆胰镜下钬激光碎石术1次予以取净。结论对于术后难取性胆管结石,胆胰镜下钬激光碎石术是安全、有效的新方法。

Objective To study the value of cholangiopancreatoscopic Holmium laser lithotripsy for the treatment of postoperative refractory bile duct stones. Methods Forty-two patients with postoperative refractory bile duct stones were treated by cholangiopancreatoscopic Holmium laser lithotripsy with 1.5-3.0 J of the output of Holmium laser and 5-10 Hz of pulse frequency. The series included 39 patients with postoperative refractory intrahepatic bile duct stones and 3 patients with extrahepatic bile duct stones that were treated by cholangioscopy unsuccessfully. Results Thirty-nine patients with postoperative refractory intrahepatic bile duct stones were treated by cholangiopancreatoscopic Holmium laser lithotripsy by 2-6 times （average 2.3 times）. There were 36 patients （92.3%, 36/39） that the intrahepatic bile duct stones were removed wholly, 4 patients with extrahepatic bile duct stones were treated by cholangiopancreatoscopic Holmium laser lithotripsy by only one time successfully. Conclusion Cholangiopancreatoscopic Holmium laser lithotripsy is a new safe and effective treatment for postoperative refractory bile duct stones.