鞘管保护下经T管窦道采用硬镜联合钬激光治疗肝内外胆管残余结石的临床效果观察

The clinical effect of the treatment of intrahepatic residual biliary calculi with holmium laser through T-tube sinus under sheath protection

目的分析鞘管保护下经T管窦道采用硬镜联合钬激光手术治疗肝内外胆道残余结石的临床效果。方法选取2019年5月—2020年5月武汉市新洲区中医医院收治的136例肝内外胆道残余结石患者,根据不同手术方案分为对照组58例,研究组78例。对照组行经T管窦道下纤维胆道镜联合钬激光手术,研究组行鞘管保护下经T管窦道硬镜联合钬激光手术,比较2组结石取净率、手术时间、住院费用、术后住院时间、并发症发生率、生活质量(SF-36评分)。结果研究组结石取净75例,结石取净率为96.15%;对照组结石取净50例,结石取净率为86.21%;差异有统计学意义(P<0.05);研究组SF-36评分为(90.5±4.7)分,高于对照组的(85.7±7.2)分,差异有统计学意义(P<0.05);研究组手术时间(68.9±19.0)min、住院费用(6843.1±960.7)元、术后住院时间(5.3±1.2)d均低于对照组的(96.1±26.3)min、(8256.7±998.1)元、(4.4±1.2)d、(7.0±1.4)d,差异有统计学意义(P<0.05);研究组并发症发生率(2.56%)低于对照组(12.07%),差异有统计学意义(P<0.05)。结论肝内外胆道残余结石患者在鞘管保护下经T管窦道采用硬镜联合钬激光手术对机体创伤小,结石清除率高,术后并发症发生率低,有效提高了患者的生活质量,疗效显著。

Objective To analyze the clinical effect of using hard endoscope combined with holmium laser to treat residual intrahepatic biliary stones through T-tube sinus under sheath protection.Methods Selected 136 patients with residual intrahepatic and extrahepatic biliary tract stones admitted to our hospital from May 2019 to May 2020.The patients were divided into a control group of 58 cases and a study group of 78 cases according to different surgical plans.The control group underwent T-tube sinus fiber choledochoscope combined with holmium laser surgery,and the study group underwent T-tube sinus surgery under sheath protection with hard endoscope combined with holmium laser.The stone removal rate,operation time,hospitalization cost,Postoperative hospital stay,complication rate,quality of life scale(SF-36 score).Results 75 cases of stone removal in the study group,with a removal rate of 96.15%,50 cases of stone removal in the control group,with a removal rate of 86.21%;the removal rate of stones in the study group was significantly higher than that of the control group,with statistical significance(P<0.05);The SF-36 score(90.5±4.7)of the study group was higher than that of the control group(85.7±7.2),and the difference was statistically significant(P<0.05);The operation time(68.9±19.0)min,hospitalization cost(6843.1±960.7)yuan,and postoperative hospital stay(5.3±1.2)d in the group were all lower than those in the control group(96.1±26.3)min,(8256.7±998.1)yuan,(4.4±1.2)d,(7.0±1.4),the difference was statistically significant(P<0.05);the complication rate of the study group(2.56%)was lower than that of the control group(12.07%),There is statistical significance(P<0.05).Conclusion In patients with residual intrahepatic biliary tract stones under the protection of the sheath,the rigid endoscope combined with holmium laser surgery through the T-tube sinus has little trauma to the body,high stone removal rate,low postoperative complications,and effectively improves the patient's quality of life,Significant effect.