腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗胆总管结石  

Laparoscopy combined choledochofiberscopy transcystic holmium laser lithotripsy in the treatment of common bile duct stones:a report of 25 cases

作　　者：陈辉[1] 章旭明[1] 范恒伟[1] 王兆洪[1] 金洲祥[1] 徐鲁白[1] 周斌[1] 张启瑜[1,2] 王继生[1] 

机构地区：[1]温州医科大学附属第二医院肝胆外科,浙江温州325000 [2]温州医科大学附属第一医院肝胆外科,浙江温州325000

出　　处：《肝胆胰外科杂志》2017年第3期192-195,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省中医药管理局青年基金项目(2014ZQ020);温州市公益性科技计划项目(Y20140694)

摘　　要：目的探讨腹腔镜联合胆道镜经胆囊管钬激光碎石术治疗胆总管下段嵌顿结石的价值及安全性。方法选取温州医科大学附属第二医院2014年7月1日至2016年6月30日收治的25例胆囊结石合并胆总管下段嵌顿结石的患者,施行经胆囊管钬激光碎石术治疗。钬激光输出功率1.0~2.0 J,脉冲频率5~10 Hz,在直视下接触结石,将结石击碎后通过取石网篮套取出结石。结果 25例行经胆囊管钬激光碎石术治疗后胆总管下段嵌顿结石均能取石成功,结石1次取净,圈套器结扎胆囊管根部,未行T管引流。手术时间(139.30±30.10)min;术中出血量(83.60±40.10)mL,术后住院时间(4.20±0.65)d。随访6~24个月,无胆道狭窄,无胆漏等发生,结石复发率4%(1/25)。结论对于胆囊管>4 mm、继发性胆总管结石患者来说,腹腔镜联合胆道镜经胆囊管钬激光碎石术是一种有效、安全的治疗方法。Objective To study the clinical value of laparoscopy combined choledochofiberscopy transcystic holmium laser lithotripsy in the treatment of common bile duct(CBD).Methods Between Jul.12014and Jun.302016,25patients diagnosed as CBD stones were treated with transcystic holmium laser lithotripsy.The generator was initially set at1.0~2.0J and5~10Hz.Then the calculi was removed after smashed.Results It was successfully performed in all the25patients.The transcystic holmium laser lithotripsy could eliminate CBD stones completely and it was unnecessary to plant a T-tube.The average operating duration was(139.30±30.10)min,the mean bleeding volume was(83.60±40.10)mL and the postoperative hospitalization was(4.20±0.65)d.There was no postoperative complication,such as biliary stricture or bile leakage.The stone recurrence rate was4%(1/25).Conclusion For the patient whose cystic duct is more than4mm,laparoscopic transcystic holmium laser lithotripsy is an effective and safe treatment for the CBD stones.

关 键 词：胆总管结石 胆道镜 钬激光 

分 类 号：R657.42[医药卫生—外科学]