ERCP联合SpyGlass DS直视下激光碎石治疗胆管困难结石的疗效及安全性分析

Efficacy and safety analysis of ERCP combined with SpyGlass DS laser lithotripsy in the treatment of difficult bile duct stones

目的评价ERCP联合SpyGlass DS直视下激光碎石治疗胆管困难结石的疗效及安全性。方法回顾性分析2014年1月至2022年12月在北京中医药大学东方医院消化内镜中心行ERCP联合SpyGlass DS直视系统行激光碎石治疗的难治性胆管结石患者的临床特征和治疗结局。记录并统计分析病例临床特征、操作情况、总体取石成功率、一次取石成功率、操作时间、并发症发生率、复发率。结果纳入的31例病例中,操作时间为(56.1±19.4)min,一次取石成功率为83.9%(26/31),总体取石成功率为90.3%(28/31)。1例(3.2%)患者出现术中出血,1例(3.2%)患者发生术后急性胰腺炎,9例(29.0%)患者出现术后高淀粉酶血症,1例(3.2%)患者发生术后出血,9例(29.0%)患者取尽结石后又出现结石复发。结论我院ERCP联合SpyGlass DS直视下激光碎石有较高的取石成功率,但术后并发症发生率较高,因本研究为回顾性分析且样本量较小,仍需更多大样本、多中心、前瞻性研究进一步研究加以验证。

Objective To evaluate the efficacy and safety of ERCP combined with SpyGlass DS laser lithotripsy in the treatment of difficult bile duct stones.Methods The clinical features and treatment outcomes of patients with re-fractory bile duct stones who received ERCP combined with SpyGlass DS laser lithotripsis at the Digestive Endoscopy Center,Dongfang Hospital,Beijing University of Chinese Medicine from Jan.2014 to Dec.2022 were retrospectively analyzed.The clinical characteristics,operation conditions,overall success rate of lithotomy,success rate of single li-thotomy,operation time,complication rate and recurrence rate of cases were recorded and statistically analyzed.Results Among the 31 included cases,the operation time was(56.1±19.4)minutes,the success rate of one-time stone removal was 83.9%(26/31),and the overall success rate of stone removal was 90.3%(28/31).Intraoperative bleeding oc-curred in 1 patient(3.2%),postoperative acute pancreatitis occurred in 1 patient(3.2%),postoperative hyperamylas-eemia occurred in 9 patients(29.0%),postoperative bleeding occurred in 1 patient(3.2%),and 9 patients(29.0%)had a recurrence of stones after all stones were removed.Conclusion In our hospital,ERCP combined with SpyGlass DS laser lithotripsy has a high success rate of stone extraction,but the incidence of postoperative complications is rela-tively high.Since this study is a retrospective analysis with a small sample size,further studies with large samples,multi-center and prospective studies are needed to confirm it.