摘要
目的:探讨腹腔镜下联合应用纤维胆道镜及iMES-I-B型微电极碎石仪治疗困难胆管结石的临床效果及安全性。方法:回顾分析2016年1月至2018年12月收治的471例肝内外胆管结石患者的临床资料,2016年1月至2017年6月共发现困难胆管结石42例,采用活检钳蚕食碎石法取石作为对照组;2017年7月至2018年12月共发现困难胆管结石44例,采用微电极碎石法作为观察组。对比分析两组患者取石时间、结石取净率、术中出血、术后胆漏发生例数及住院时间等指标。结果:观察组取石时间平均(43.7±12.3)min,对照组平均(78.3±16.6)min,两组差异有统计学意义(P<0.05)。观察组结石取净率为100%(44/44),对照组为90.5%(38/42),两组差异无统计学意义(P>0.05)。观察组术中出血3例,对照组未发生出血;术后两组分别发生胆漏2例。观察组术后平均住院(10.5±2.2)d,对照组平均(10.2±2.4)d,两组差异均无统计学意义(P>0.05)。结论:iMES-I-B型体内微电极碎石仪可显著提高取石效果,为临床顺利处理困难胆管结石提供了安全、可靠的碎石方法。
Objective:To investigate the clinical effect and safety of laparoscopy combined with fibrocholedochoscopy and iMES-I-B microelectrode lithotripsy in the treatment of difficult bile duct stones.Methods:The clinical data of 471 patients with extrahepatic and intrahepatic bile duct stones treated from Jan.2016 to Dec.2018 were retrospectively analyzed.Among them,42 patients with difficult bile duct stones underwent biopsy forceps lithotripsy from Jan.2016 to Jun.2017(control group).44 patients with difficult bile duct stones underwent microelectrode lithotripsy from Jul.2017 to Dec.2018(observation group).The time of stone removal,stone free rate,intraoperative hemorrhage,postoperative bile leakage and hospital stay were compared between the two groups.Results:The average time of stone removal was(43.7±12.3)min in observation group and(78.3±16.6)min in control group,the difference was statistically significant(P<0.05).The stone free rate were 100%(44/44)in observation group and 90.5%(38/42)in control group,the difference was not statistically significant(P>0.05).The intraoperative hemorrhage(3 vs.0),postoperative bile leakage(2 vs.2)and hospitalization time[(10.5±2.2)d vs.(10.2±2.4)d]between the observation group and control group did not differ in a statistically significant way(P>0.05).Conclusions:iMES-I-B microelectrode lithotripsy instrument can significantly improve the efficiency of stone removal.It provides a safe and reliable method for clinical treatment of difficult bile duct stones.
作者
张伟
尚培中
吕瑞昌
吉玉洁
南润玲
李晓武
苗建军
张金江
蔡大伟
赵伟男
张洁
ZHANG Wei;SHANG Pei-zhong;LV Rui-chang(Department of General Surgery,the Hospital of PLA 81st Group Army,Zhangjiakou 075000,China)
出处
《腹腔镜外科杂志》
2019年第8期603-607,共5页
Journal of Laparoscopic Surgery
基金
张家口市科学技术研究与发展计划项目(1821115D)
关键词
胆管结石
腹腔镜检查
胆道镜检查
微电极碎石
Cholangiolithiasis
Laparoscopy
Choledochoscopy
Microelectrode lithotripsy
