经皮经肝胆道镜钬激光与气压弹道碎石取石术治疗肝内外胆管结石疗效分析

Curative effect of percutaneous transhepatic choledochoscopic holmium laser and pneumatic ballistic lithotripsy in the treatment of intrahepatic and extrahepatic bile duct stones.

目的比较经皮经肝胆道镜钬激光与气压弹道碎石取石术治疗肝内外胆管结石的临床疗效。方法选取2013年1月至2019年1月汉中市人民医院普外科收治的100例肝内外胆管结石患者为研究对象,以随机临床同期对照研究及患者自愿原则分为甲组和乙组,每组50例。两组患者均经肝胆道镜治疗,甲组患者采取钬激光碎石治疗,乙组采取气压弹道碎石术治疗,比较两组患者的手术时间、术中出血量、住院时间和并发症发生情况;同时比较两组患者术前、术后2周的血清胆红素(TBil)、谷丙转氨酶(ALT)、谷草转氨酶(AST)水平;并统计两组患者一次成功碎石率、术后2周的结石排净率和随访1年时的结石复发情况。结果甲组患者的手术时间、术中出血量分别为(85.24±13.59)min、(16.43±4.22)mL,明显短(少)于乙组的(89.36±15.74)min、(19.65±5.68)mL,差异均有统计学意义(P<0.05);甲组患者的一次碎石成功率和术后2周结石排净率分别为88.0%,92.0%明显高于乙组的70.0%,76.0%,差异均有统计学意义(P<0.05);术后2周,甲组患者的TBil和AST水平分别为(18.32±3.15)μmol/L、(40.28±7.36)U/L,分别与乙组的(19.33±3.01)μmol/L、(41.03±8.04)U/L比较差异均无统计学意义(P>0.05),但甲组患者术后2周的ALT水平为(40.36±4.55)U/L,明显低于乙组的(44.25±4.69)U/L,差异有统计学意义(P<0.05);甲组患者术后并发症发生率为2.0%,明显低于乙组的16.0%,差异有统计学意义(P<0.05);甲组患者1年后的结石复发率为2.0%,明显低于乙组的16.0%,差异有统计学意义(P<0.05)。结论经皮经肝胆道镜钬激光与气压弹道碎石取石术治疗肝内外胆管结石均能取得满意效果,但钬激光碎石术碎石成功率更高,结石清除效果更好,在安全性和防止复发方面更有优势。

Objective To compare the clinical effects of percutaneous transhepatic choledochoscopic holmium laser and pneumatic ballistic lithotripsy in the treatment of intrahepatic and extrahepatic bile duct stones.Methods One hundred patients with intrahepatic and extrahepatic bile duct stones admitted to Hanzhong People's Hospital from January 2013 and January 2019 were selected as study subjects.They were divided into the group A and group B according to the randomized concurrent control trial and the voluntary principal of patients,with 50 patients in each group.Both groups received transhepatic choledochoscopic treatment.Group A was treated with holmium laser lithotripsy,while group B was treated with pneumatic ballistic lithotripsy.The operation time,intraoperative blood loss,hospitalization time,incidence of complications,levels of serum bilirubin(TBil),alanine aminotransferase(ALT),and aspartate aminotransferase(AST)before operation and at 2 weeks after operation were compared between the two groups.The success rate of one-time lithotripsy,stone clearance rate at 2 weeks after operation and stone recurrence at 1 year follow-up were counted.Results The operation time and intraoperative blood loss of group A were(85.24±13.59)min and(16.43±4.22)mL,which were significantly shorter/less than(89.36±15.74)min and(19.65±5.68)mL of group B(P<0.05).The success rate of one-time lithotripsy and stone clearance rate in 2 weeks after operation in group A were 88.0%and 92.0%,which were significantly higher than 70.0%and 76.0%in group B(P<0.05).Two weeks after operation,the levels of TBil,AST in group A were(18.32±3.15)μmol/L,(40.28±7.36)U/L,which were not significantly different from those in(19.33±3.01)μmol/L,(41.03±8.04)U/L(P>0.05).However,the ALT level in group A was(40.36±4.55)U/L,which was significantly lower than(44.25±4.69)U/L in group B(P<0.05).The incidences of postoperative complications and stone recurrence rate in 1 year after operation in group A were 2.0%and 2.0%,which were significantly lower than 16.0%and 16.0%in group B(P<0.05).Conclusion Both percutaneous transhepatic choledochoscopic holmium laser and pneumatic ballistic lithotripsy can achieve satisfactory results in the treatment of intrahepatic and extrahepatic bile duct stones.However,holmium laser lithotripsy has higher success rate,better stone removal effect.Besides,it has more advantages in terms of safety and prevention of recurrence.