输尿管硬镜联合钬激光在肝胆管结石合并胆汁性肝硬化疾病中的应用  

Application of ureteroscope combined with holmium laser in hepatolithiasis complicated with biliary cirrhosis

作　　者：陈晨[1] 王蕾[1] 汪新天[1] 李浩[1] 何自力[1] 米杨 Chen Chen;Wang Lei;Wang Xintian;Li Hao;He Zili;Mi Yang(Five Wards of Hepatology Department,The First Affiliated Hospital of Hunan Normal University(Hunan People's Hospital),Changsha 410000,China)

机构地区：[1]湖南师范大学附属第一医院(湖南省人民医院)肝胆五科,长沙410000

出　　处：《中国医师杂志》2021年第10期1506-1509,共4页Journal of Chinese Physician

基　　金：湖南省科技创新计划项目(2018SK50708);湖南省教育厅科研计划项目(19C1183);湖南省肝胆胰肠诊治能力提升项目(湘卫[2019]118号)。

摘　　要：目的探讨输尿管硬镜联合钬激光技术在肝胆管结石合并胆汁性肝硬化患者中的应用。方法收集2014年2月至2019年12月湖南省人民医院肝胆科收治的合并有胆汁性肝硬化的89例肝胆管结石患者的临床资料,将其分为A、B两组,其中A组为常规手术组,B组为应用输尿管硬镜、钬激光技术组,将两组临床资料进行比较分析。结果B组手术时间较A组少[(302.6±96.7)min vs(349.2±105.6)min,P<0.05];B组术中出血量较A组少[(227.7±197.3)ml vs(331.4±277.4)ml,P<0.05];B组术后住院时间较A组短,差异有统计学意义[(11.5±4.1)d vs(13.8±5.1)d,P<0.05];B组术后并发症发生率较A组低(2.44%vs 18.75%,P<0.05)。B组肝脏切除率低于A组(29.27%vs 52.08%,P<0.05)。结论通过建立合理的入肝通路,将输尿管硬镜联合钬激光应用于肝胆管结石合并胆汁性肝硬化患者的外科治疗,可获得较满意的临床疗效,此项技术可逐步推广应用于临床。Objective To explore the application of ureteroscope combined with holmium laser in patients with hepatolithiasis complicated with biliary cirrhosis.Methods The clinical data of 89 patients with hepatolithiasis complicated with biliary cirrhosis treated in the hepatobiliary department of Hunan Provincial Peopled Hospital from February 2014 to December 2019 were collected and divided into two groups;group A was routine operation group and group B was ureteroscopy and holmium laser technology group.The clinical data of the two groups were compared and analyzed respectively.Results The operation time in group B was less than that in group A[(302.6±96.7)min vs(349.2±105.6)min,P<0.05],with statistically significant difference;The amount of intraoperative bleeding in group B was less than that in group A[(227.0±197.3)ml vs(331.4±277.3)ml,P<0.05],with statistically significant difference;The postoperative hospital stay in group B was shorter than that in group A[(11.5±4.1)d vs(13.8±5.l)d,P<0.05],with statistically significant difference;The incidence of postoperative complications in group B was lower than that in group A(2.44%vs 18.75%,P<0.05),with statistically significant difference.The liver resection rate in group B was lower than that in group A(29.27%vs 52.08%,P<0.05).Conclusions Through the establishment of a reasonable access to the liver,the application of ureteroscope and holmium laser technology in patients with hepatolithiasis complicated with biliary cirrhosis can achieve better diagnosis and treatment results,and this technology can be gradually promoted and applied in the clinic.

关 键 词：肝硬化 胆汁性 肝胆管结石 输尿管镜检查 钬激光 

分 类 号：R657.3[医药卫生—外科学] R657.4[医药卫生—临床医学]