腹腔镜下胆道镜联合钬激光碎石治疗肝内外胆管结石

The application in the treatment of extra - and intrahepatic cholangiolithiasis by laparoscopy with choledochoscope combined with holmium laser lithotripsy

目的探讨腹腔镜下胆道镜联合钬激光治疗肝内外胆管结石的疗效及应用价值。方法回顾性分析我院收治的60例肝内外胆管结石患者分为对照组与观察组，每组各30例。对照组行腹腔镜下胆道镜＋网篮取石，观察组行腹腔镜下胆道镜＋钬激光碎石，比较其临床疗效。结果对照组结石完全取尽25例（占83．3％），平均手术时间（135±32）min，平均住院时间（8．0±3．1）天，中转开腹手术2例；术后残余结石4例，后经T管窦道用胆道镜取出，术后胆漏3例。观察组结石完全取尽28例（占93．3％），平均手术时间（100±25）min，平均住院时间（8．2±3．3）天，无中转开腹手术，术后残余结石1例，后经T管窦道用胆道镜取出，术后无胆漏等并发症发生。观察组在术后结石残留率、术后胆漏发生率、平均手术时间上均优于对照组，差异具有统计学意义（P〈0．05）。结论采用腹腔镜下胆道镜联合钬激光碎石治疗肝内外胆管结石术中取尽率高、并发症发生率低、疗效确切。

Objective To investigate the therapeutic effect and application value in the treatment of intra - and extra- hepatolithiasis by laparoseopy with choledochoscope combined with holmium laser lithotripsy. Methods Sixty patients who suffered from intra - and extra - hepatolithiasis were divided into two groups. Control group, 30 cases were treated with laparoscopy and choledochoscope. Observation group, 30 cases were treated with laparoscopy and choledo- choscope combined with holmium laser lithotripsy. Clinical results were compared between the two groups. Results Control group： all stones were removed completely in 25 eases with the success rate of 83.3%. Mean operating time was （ 135 ± 32） min, Mean hospital stay was （8.0 ± 3.1 ） days, 2 cases were converted to open operation. 4 cases existed residual stones, who were treated by choledochoscope through T tubules sinus tract. 3 cases developed postoperative bile leakage and they were cured through conservative treatment. Observation group： the stones were removed completely in 28 cases with the success rate of 93.3%. Mean operating time was （100 ± 25） min, Mean hospital stay was （8.2 ± 3. 3 ） days. One case existed residual stones, who was treated by choledochoscope through T tubules sinus tract. No cases developed postoperative bile leakage. There was significant difference in the groups of patients in the success rate of removal stones, incidence of postoperative bile leakage （P 〈 0.05 ）. Conclusions It is safe and effective to treat intra - and extra - hepatolithiasis by laparoscopy with choledochoscope combined with holmium laser lithotripsy