经口直视胆道内镜联合液电碎石对难治性胆总管结石的诊疗价值  

The Value of Direct-oral Biliary Endoscopy Combined with Electro-hydraulic Lithotripsy in the Diagnosis and Treatment of Refractory Common Bile Duct Stones

作　　者：安代红 陶锐 周晓宏 陈聪[1] 张祥[1] 张超超 曾燕琴 An Daihong;TAO Rui;ZHOU Xiaohong;CHEN Cong;ZHANG Xiang;ZHANG Chaochao;ZENG Yanqin(Department of Hepatobiliary Surgery,Bishan Hospital,The First Affiliated Hospital of Chongqing Medical University,Chongqing,402760 China)

机构地区：[1]重庆医科大学附属第一医院璧山医院肝胆外科,重庆402760

出　　处：《系统医学》2021年第22期166-169,共4页Systems Medicine

摘　　要：目的探究经口直视胆道内镜(DPOC)联合液电碎石在治疗难治性胆总管结石中的临床效果和推广价值。方法选取2018年1月—2019年1月期间该院接收的60例难治性胆总管结石患者,通过随机数字表法对其分组,分为DPOC组和ERCP组,每组30例患者。对DPOC组患者进行DPOC联合液电碎石的手术方法进行治疗,对ERCP组患者采用经内镜逆行胰胆管造影术(ERCP)进行治疗。治疗结束后观察并统计比较两组的结石发现率、手术时间、一次性结石取净率、总结石取净率、患者住院时间、并发症发生情况以及一年内复发率和病死率指标。结果DPOC组和ERCP组手术过程中都能成功发现结石,成功率均达到100.00%。DPOC组患者接受手术的平均时间为(40.25±5.31)min,显著少于ERCP组(52.10±6.09)min,差异有统计学意义(t=8.030,P<0.05);两组患者的总结石取净率分别为93.33%和90.00%,差异无统计学意义(χ^(2)=0.000,P>0.05);DPOC组的一次性结石取净率(86.67%)显著高于ERCP组(60.00%),差异有统计意义(χ^(2)=5.454,P<0.05);两组患者的平均住院时间比较,差异无统计学意义(t=0.857,P>0.05);DPOC组患者的并发症总发生率(3.33%)显著低于ERCP组(26.67%),差异有统计学意义(χ^(2)=4.706,P<0.05);两组患者在治疗后均无死亡情况发生,病死率均为0.00%;DPOC组一年内病情复发率(6.67%)略低于ERCP组(10.00%),差异无统计学意义(χ^(2)=0.000,P>0.05)。结论DPOC与ERCP都是临床上治疗难治性胆总管结石效果较好且安全性较高的方法,但相较于ERCP,DPOC联合液电碎石更具有诊疗优势,值得临床上推广。Objective To explore the clinical effect and promotion value of direct-oral biliary endoscopy(DPOC)combined with laser lithotripsy in the treatment of refractory common bile duct stones.Methods The subjects selected for the study were 60 patients with refractory choledocholithiasis admitted to the hospital from January 2018 to January 2019.They were divided into two groups by random number table method,namely DPOC group and ERCP group.There were 30 patients in each group.Patients in the DPOC group were treated with DPOC combined with electrohydraulic lithotripsy,and patients in the ERCP group were treated with endoscopic retrograde cholangiopancreatography(ERCP).After the treatment,the two groups were observed and statistically compared the stone discovery rate,operation time,one-time stone removal rate,summary stone removal rate,patient hospitalization time,complications,recurrence rate and mortality rate within one year and other indicators.Results Both the DPOC group and the ERCP group were able to successfully find stones during the operation,and the success rate was 100.00%.The average time for the DPOC group to undergo surgery was(40.25±5.31)min,which is significantly less than the ERCP group(52.10±6.09)min,the difference was statistically significante(t=8.030,P<0.05);the summary stone removal rates of the two groups were 93.33%and 90.00%,respectively,and the difference was not statistically significant(χ^(2)=0.000,P>0.05);the one time removal rate of sex stones(86.67%)in the DPOC groupwas significantly higher than that of the ERCP group(60.00%),and the difference was statistically significant(χ^(2)=5.454,P<0.05);compared the average hospital stay between the two groups,the difference was not statistically significant(t=0.857,P>0.05);the total incidence of complications in the DPOC group(3.33%)was significantly lower than that in the ERCP group(26.67%),and the difference was statistically significant(χ^(2)=4.706,P<0.05);both groups of patients after treatment no death occurred,and the mortality rate wa

关 键 词：经口直视胆道内镜 液电碎石 难治性胆总管结石 诊疗价值 

分 类 号：R657.4[医药卫生—外科学]