内镜下双频双脉冲激光碎石与传统机械碎石在胆总管结石患者中的疗效比较  

Comparison of therapeutic effects of endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet laser and traditional mechanical lithotripsy in patients with common bile duct stones

作　　者：樊啸 戚晓亮[1] 祝一鸣 黄明哲 楼晓楼[1] 夏焱 FAN Xiao;QI Xiaoliang;ZHU Yiming;HUANG Mingzhe;LOU Xiaolou;XIA Yan(Department of General Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201999,P.R.China)

机构地区：[1]上海交通大学医学院附属第九人民医院普外科,上海201999

出　　处：《中国普外基础与临床杂志》2020年第9期1112-1116,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的比较内镜下双频双脉冲激光碎石与内镜下传统机械碎石治疗胆总管结石患者的疗效差异。方法回顾性分析2009年3月至2019年3月期间在上海交通大学医学院附属第九人民医院普外科行ERCP治疗并碎石的207例胆总管结石患者的临床资料,其中71例患者采用双频双脉冲激光碎石术(激光组),136例患者采用机械碎石(机械组),比较2组患者的取石成功率、手术时间、术后住院时间、住院费用、耗材费用、并发症等情况。结果2组患者一般情况、术前临床资料等基线资料基本一致(P>0.05)。激光组和机械组均无围术期死亡患者。2组患者术后常规实验室生化指标、耗材费用、住院费用及出血、术后胰腺炎、穿孔和胆管感染并发症率比较差异均无统计学意义(P>0.05)。虽然激光组的手术时间明显长于机械组(P<0.05),但是与机械组相比,激光组的取石成功率更高(P<0.05)、术后住院时间更短(P<0.05)、总并发症率和结石残留率更低(P<0.05)。结论双频双脉冲激光碎石治疗胆总管结石具有比传统手术机械碎石更好的疗效及更低的并发症率,但手术时间仍有改进的空间。Objective To compare difference of therapeutic effects between endoscopic frequency-doubled double pulse neodymium yttrium aluminium garnet(FREDDY)laser and endoscopic traditional mechanical lithotripsy in treatment of common bile duct stones(CBDs).Methods The clinical data of 207 patients with CBDs treated with ERCP and lithotripsy in the Ninth People’s Hospital Affiliated to Shanghai Jiaotong University School of Medicine from March 2009 to March 2019 were analyzed retrospectively,of which 71 cases treated by FREDDY(FREDDY group)and 136 cases treated by mechanical lithotripsy(mechanical group).The success rate of stone removal,operation time,postoperative hospitalization time,hospitalization cost,consumables cost,and complications were compared between the two groups.Results There were no significant differences in the general condition and the preoperative clinical data between the two groups(P>0.05).There was no perioperative death in the two groups.There were no significant differences in terms of the postoperative routine laboratory biochemical indexes,consumables cost,hospitalization cost,and rates of the bleeding,postoperative pancreatitis,perforation and biliary tract infection between the two groups(P>0.05).Although the operation time of the FREDDY group was significantly longer than that of the mechanical group(P<0.05),the success rate of stone removal was significantly higher,the postoperative hospitalization time was shorter,the total complications rate and stone residual rate were significantly lower in the FREDDY group as compared with the mechanical group(P<0.05).Conclusion Endoscopic FREDDY laser lithotripsy has a better curative effect and less complications in treatment of large CBDs than mechanical lithotripsy,but operation time needs further to be improved.

关 键 词：胆总管结石 双频双脉冲激光碎石 机械碎石 疗效 

分 类 号：R657.4[医药卫生—外科学]