胆道镜联合钬激光碎石与部分肝切除治疗Ⅰ型肝内胆管结石对比分析

Cholangioscopy combined with holmium laser lithotripsy compared with partial hepatectomy in the treatment of type I intrahepatic bile duct stones

目的探讨应用胆道镜联合钬激光碎石治疗I型肝内胆管结石的手术方法、疗效在治疗I型肝内胆管结石方面的优势。方法回顾性分析该院2012年8月至2016年6月收治的53例I型肝内胆管结石患者的临床资料，分为研究组（28倒）好对照组（25例）。研究组行胆道镜联合钬激光碎石治疗，对照组行部分肝叶切除治疗。结果研究组患者中Ⅳ级胆管中存在少量细小结石2例，因胆道镜不能进入无法取出细小结石，结石取净率为92．8％，术后肝功能轻度受损（AST〈50IU／L、ALT〈45IU／L），无感染、胆漏、胆道大出血等严重并发症。对照组患者中Ⅲ级或Ⅳ级胆管中存在少量细小结石2例，结石取净率为92．0％，肝功能受损2例（AST〉120IU／L、ALT〉120IU／L），术后感染2例，胆漏2例。研究组患者手术时间、手术失血量、术后平均住院时间、术后并发症发生率均明显优于对照组，差异均有统计学意义（P〈o．05）。两组患者结石取净率比较差异无统计学意义（P〉0．05）。研究组患者术后随访1年B超复查未发现结石复发。结论胆道镜联合钬激光碎石治疗I型肝内胆管结石精准、微创、手术操作方法简单、安全、可靠、疗效确切，适合临床推广应用。

Objective To investigate the surgical methods, efficacy and advantages of cholangioscopy combined with holmium laser lithotripsy in the treatment of type I intrahepatic bile duct stones. Methods The clinical data of 53 type I intrahepatic bile duct stone patients of the first affiliated hospital of Kunming Medical University underwent surgical treatment from August 2012 to June 2016 were retrospectively analyzed, patients were divided into two groups, patients in experimental group （28 cases） had cholangios- copy combined with holmium laser lithotripsy and patients in control group（25 cases） had partial hepatectomy. Results 26 cases （92.85 % ）had the stones completely removed in the experimental group,and there were 2 cases of residual stones, no postoperative infection, no bile leakage and no serious complications such as bile duct hemorrhage;23 cases（92.0%） had the stones completely re- moved in the control group,there were 2 cases of residual stones,2 cases of postoperative infection,2 cases of bile leakage and 2 ea- ses of liver damage. The operation time, blood loss during operation, average postoperative hospital stay and postoperative complica- tion rate of experimental group were significantly better than control group （P〈0.05）; there was no significant difference in the stone--cleaned rate of each group （P^0.05）. We conducted postoperative follow up of 1 year in the experimental group, B-mode ultrasonography found no recurrence of stones. Conclusion Cholangioscopy combined with holmium laser lithotripsy was precise, minimally invasive,the surgical method of operation is simple, safe, and effective in the treatment of type I intrahepatic bile duct stones,it was suitable for clinical application.