双镜联合钬激光治疗难取性肝内外胆管结石10例临床分析

Clinical analysis of 10 cases of difficult intrahepatic and extrahepatic bile duct stones treated by double mirror combined with holmium laser

目的探讨双镜(腹腔镜+胆道镜)联合钬激光治疗难取性肝内外胆管结石的安全性和疗效。方法收集我院2015-01~2017-05难取性胆道结石病例10例,先行腹腔镜胆囊切除术,再通过胆道镜工作道,运用钬激光对大而紧密嵌顿的结石进行精确碎石,后0.9%生理盐水冲洗或取石篮取出。结果 10例难取性胆道结石均完全取出,术后无胆管损伤、出血、胆漏等并发症,随诊6-12月,均无结石复发及胆管狭窄。结论双镜联合钬激光碎石术是一种精确、直观、创伤小、效果好的术式,是治疗难取性胆道结石有效的方法。

Objective To evaluate the safety and efficacy of double mirror（ laparoscopic and choledochoscope） combined with holmium laser in the treatment of difficult intrahepatic and extrahepatic bile duct stones. Methods Ten difficult biliary calculi patients were collected in our hospital from January 2015 to May 2017. All patients were treated by the laparoscopic cholecystectomy,and then the bile duct stones were smashed by holmium laser via choledochoscope and removed after flushing by 0. 9% physiological saline or with the stone basket. Results The difficult biliary calculi from 10 cases were completely removed. There were no bile duct injury,bleeding,bile leakage and other complications after operation. After followed up for 6-12 months,there was no recurrence of stones and bile duct stricture. Conclusion Lithotripsy by laparoscopic choledochoscope combined with holmium laser is accurate,intuitive,and minimally invasive,and it has good effect in the treatment of difficult bile duct stones.