钬激光联合纤维胆道镜治疗肝内外胆管结石的效果观察

Clinical effect of holmium laser lithotripsy combined with fiber choledochoscope in treatment of intra-and extra-hepatolithiasis

目的探讨钬激光联合纤维胆道镜治疗肝内外胆管结石患者的临床效果。方法收集2012年1月-2014年7月于北京市昌平区中医医院治疗的肝内外胆管结石患者64例,其中进行纤维胆道镜治疗33例(称为纤维胆道镜组),钬激光联合纤维胆道镜治疗31例(称为联合组),对两组一次性取净结石率和并发症发生率进行分析比较。计数资料组间比较采用χ2检验,计量资料组间比较采用t检验。结果纤维胆道镜组一次性取净结石率为72.73%(24/33),并发症发生率为21.21%(7/33);联合组一次性取净结石率为93.55%(29/31),并发症发生率为3.23%(1/31)。两组一次性取净结石率、并发症发生率比较差异均有统计学意义(χ2值分别为4.868、4.728,P值分别为0.027、0.030)。结论钬激光联合纤维胆道镜治疗能够有效提高肝内外胆管结石患者的一次性取净结石率及降低并发症发生率,是值得临床推广的有效治疗方法。

Objective To evaluate the clinical effect of holmium laser lithotripsy combined with fiber choledochoscope in the treatment of intra- and extra- hepatolithiasis. Methods Sixty- four patients who were diagnosed with intra- and extra- hepatolithiasis in our hospital from January 2012 to July 2014 were assigned to receive fiber choledochoscope treatment（ 33 cases） or holmium laser lithotripsy combined with fiber choledochoscope（ 31 cases）. The one- time stone removal rate and incidence of complications were compared between the two groups. Comparison of categorical data was made by chi- square test,while comparison of continuous data was made by t test. Results The fiber choledochoscope group had a significantly lower one- time stone removal rate and a significantly higher incidence of complications compared with the combination therapy group（ 72. 73%（ 24 /33） vs 93. 55%（ 29 /31）,χ2= 4. 868,P = 0. 027; 21. 21%（ 7 /33） vs3. 23%（ 1 /31）,χ2= 4. 728,P = 0. 030）. Conclusion Holmium laser combined with fiber choledochoscope can effectively increase the one- time stone removal rate and reduce the incidence of complications in patients with intra- and extra- hepatolithiasis. This therapy holds promise for clinical application.