摘要
背景肝胆管结石常见于我国南方地区.而复杂性肝胆管结石由于其病情复杂、手术后残石率及复发率较高,成为胆道外科的一个难点.近年来随着影像学技术的进步及外科医生手术技巧的提高,各种解剖技术、内镜系统以及碎石手段的联合应用,在治疗复杂肝胆管结石中取得了较好的效果.目的探讨输尿管硬镜及钬激光结合高位胆管切开术在复杂肝胆管结石上的治疗效果.方法回顾性分析我科2013-01/2018-12的115例复杂肝胆管结石病例.比较44例术中使用纤维胆道镜及71例术中使用输尿管硬镜及钬激光结合高位胆管切开患者的术中出血量、术后平均住院时间、术后残石率有无差异.结果术中使用纤维胆道镜患者平均术中出血量237.5 mL,平均术后住院天数14.2 d,术后残石率13.6%;术中使用输尿管硬镜及钬激光结合高位胆管切开手术患者平均术中出血量185.2 mL,平均术后住院天数11.0 d,术后残石率2.5%.本研究中输尿管硬镜组术中出血量、术后住院天数及残石率均优于纤维胆道镜组.结论输尿管硬镜及钬激光结合高位胆管切开在治疗复杂肝胆管结石上取得较满意的临床效果,具有较广阔的临床应用前景,但此临床技术仍需要在经验丰富的高年资胆道外科专科医师指导下逐步开展.术前建议常规行磁共振胰胆管成像检查,明确胆树形态及可能存在的胆道变异,结合术中超声的使用,以减少术中意外胆管损伤及胆管出血等并发症的发生,降低术后残石率.
BACKGROUND Hepatobiliary stones are commonly found in southern China.Complex hepatobiliary stones have become a difficult problem in biliary surgery because of their complexity and high residual stone rate and recurrence rate after surgery.In recent years,with the advancement of imaging technology and the improvement of surgical skills,the combined application of various anatomical techniques,endoscopic systems,and lithotripsy has achieved better results in the treatment of complicated hepatobiliary stones.AIM To evaluate the effect of rigid ureteroscopy and holmium laser combined with high bile duct incision to cure complex hepatolithiasis.METHODS A retrospective analysis was performed on 115 complex hepatolithiasis cases at our department from January 2013 to December 2017.We compared the difference in average intraoperative blood loss,average length of stay in hospital after operation,postoperative complications,and residual calculi after operation between 44 cases undergoing choledochoscopic surgeryith and 71 undergoing rigid ureteroscopy and holmium laser combined with high bile duct incisionion.RESULTS In the choledochoscopic surgery group,the average intraoperative blood loss was 237.5 mL,the average length of stay in hospital after operation was 14.2 d,and the residual stone rate was 4.5%;the corresponding values in the combination group were 185.2 mL,11.0 d,and 2.5%,respectively.There were significant differences in intraoperative blood loss and postoperative hospitalization days between the two groups.The postoperative residual stone rate and postoperative complication rate were significantly lower in the combination group than in the choledochoscopic surgery group.CONCLUSION Postoperative residual stone rate and postoperative complication rate are lower in patients undergoing rigid ureteroscopy and holmium laser combined with high bile duct incision than in those undergoing choledochoscopic surgery.The combination therapy can reduce postoperative hospital stay and intraoperative blood loss,and can be regarded as an excellent operation for patients with complicated hepatolithiasis.
作者
陈晨
李业荣
吴金术
米杨
汪新天
Chen Chen;Ye-Rong Li;Jing-Shu Wu;Yang Mi;Xin-Tian Wang(Department of Hepatobiliary Surgery,Hunan Provincial People’s Hospital(The First Affiliated Hospital of Hunan Normal University),Changsha 410000,Hunan Province,China)
出处
《世界华人消化杂志》
CAS
2021年第12期655-661,共7页
World Chinese Journal of Digestology
基金
湖南省创新引导计划--临床医疗技术创新引导项目,No.2018SK50708
湖南省教育厅科研计划项目,No.19C1183
湖南省卫生健康委员会科研计划项目,No.C2016005.
关键词
输尿管硬镜
钬激光
复杂肝胆管结石
Rigid ureteroscopy
Holmium laser
Complex hepatolithiasis
