经输尿管镜结合钬激光在肝内外胆管结石切开取石术中的应用体会

Application of holmium laser combined with ureteroscope in incision and lithotomy of intrahepatic and extrahepatic bile duct stones

目的探讨在没有纤维胆道镜的情况下用输尿管镜代替胆道镜行肝胆管切开探查碎石取石的可行性和安全性。方法回顾性分析26例输尿管镜在肝胆管切开取石中应用的疗效和经验。结果 26例患者手术全部成功,患者的平均手术时间为(1.23±0.25)h,平均住院时间为(9.15±0.12)d,术中出血量为(46.35±11.42)m L,术后排气时间为(56.22±26.04)h,术后胆红素指数为(35.14±10.36)μmol/L,术后镇痛药物使用率为19.23%(5/26),通过2个月的随访发现,该治疗方式的碎石成功率为100%,且无血尿等泌尿系统损伤及其它不良反应的发生。结论在缺乏纤维胆道镜的情况下应用输尿管镜在肝胆管切开时进行探查碎石取石是可行的也是安全的,并且减少了并发症的发生,缩短了手术时间及患者的住院时间。

Objective To explore the feasibility and safety of using choledochoscope instead of Choledochoscope for the exploration and removal of gravel in the absence of fiber choledochoscope. Methods The efficacy and experience of ureteroscopy in the treatment of bile duct incision lithotomy in 26 cases were retrospectively analyzed. Results The operation was successful in all 26 patients,The average operation time of the patients was （1.23 ± 0.25）h,the average hospitalization time was （9.15 ± 0.12） days,the amount of hemorrhage was （46.35 ± 11.42）mL,postoperative exhaust time was （56.22 ± 26.04）h,postoperative biliruhin index was （35.14 ±10.36）μL mol/L,The postoperative analgesic use rate was 19.23%（5/26）,After 2 months of follow-up,The success rate of lithotripsy was 100%,and no hematuria and other adverse reactions occurred. Conclusion In the absence of fiber choledochoscope,it is feasible and safe to use ureteroscopy to explore the stones during the incision of the bile duct,it also reduces the incidence of complications,shortens the operation time and stays in hospital.