SpyGlass系统监视在胆总管结石辅助液电碎石中的应用  

Utility of SpyGlass system-guided electrohydraulic lithotripsy for choledocholithiasis

作　　者：蒙钊[1] MENG Zhao(Department of Gastroenterology,the Second People's Hospital of Qinzhou,Qinzhou 535000,China)

机构地区：[1]钦州市第二人民医院消化内科,广西钦州535000

出　　处：《中国医学物理学杂志》2023年第11期1428-1432,共5页Chinese Journal of Medical Physics

基　　金：钦州市科学研究与技术开发计划(201910305)。

摘　　要：目的:探讨经口胆管镜直视系统(SpyGlass系统)在胆总管结石患者治疗中的应用价值。方法:选取120例胆总管结石患者,采用随机数字表法将其分为联合组和对照组,各60例。对照组采用经内镜逆行胰胆管造影及液电碎石术治疗,联合组在对照组基础上同时采用SpyGlass系统;比较两组患者胆管直径、结石数目、结石直径、手术时间、X线暴露时间、一次性碎石成功率、术中出血率、手术前后患者肝功能指标(TBIL、ALT、AST、γ-GT)、C反应蛋白(CRP)、白细胞(WBC)以及手术并发症差异。结果:联合组与对照组的胆管直径、结石数目、结石直径、术中出血率比较,差异均无统计学意义(P>0.05);联合组的手术时间、X线暴露时间显著短于对照组,联合组的一次性碎石成功率高于对照组,差异具有统计学意义(P<0.05)。术前,联合组与对照组的肝功能指标(ALT、AST、TBIL、γ-GT)、CRP、WBC比较,差异无统计学意义(P>0.05);术后48 h,比较联合组和对照组的肝功能指标(ALT、AST、TBIL、γ-GT)、CRP、WBC,差异仍无统计学意义(P>0.05),但联合组与对照组治疗后均可显著改善肝功能,降低CRP、WBC(P<0.05)。联合组并发症发生率显著低于对照组(3.33%vs 13.33%,P<0.05)。结论:胆总管结石患者采用SpyGlass系统技术实施碎石治疗能有效缩短手术时间及X线暴露时间,提高一次性碎石效果,降低手术并发症发生率。Objective To explore the application value of SpyGlass system in the treatment of choledocholithiasis.Methods A total of 120 patients with choledocholithiasis were enrolled and randomly divided into a combined group and a control group,with 60 cases each.The control group was treated with endoscopic retrograde cholangiopancreatography and electrohydraulic lithotripsy,while SpyGlass system was used in combined group in addition to the treatments given to control group.The two groups were compared in terms of bile duct diameter,number of stones,stone diameter,surgical duration,X-ray exposure duration,success rate for a first attempt at lithotripsy,intraoperative bleeding rate,liver function indicators(TBIL,ALT,AST,γ-GT),C-reactive protein(CRP),white blood cells(WBC),and surgical complications.Results There was no statistically significant difference in bile duct diameter,number of stones,stone diameter,and intraoperative bleeding rate between two groups(P>0.05).Compared with control group,combined group had shorter surgical duration and X-ray exposure duration,and higher success rate for a first attempt at lithotripsy(P<0.05).The differences between two groups in liver function indicators(ALT,AST,TBIL,γ-GT),CRP,andWBC before surgery and at 48 h after surgery were trivial(P>0.05);and the treatments of both combined group and control group significantly improved liver function,and reduced CRP and WBC(P<0.05).The incidence of complications in combined group was 3.33%,significantly lower than the 13.33%in control group(P<0.05).Conclusion SpyGlass system-guided lithotripsy for choledocholithiasis can effectively shorten surgical duration and X-ray exposure duration,improve the success rate for a first attempt at lithotripsy,and reduce the incidence of surgical complications.

关 键 词：胆总管结石 经口胆管镜直视系统 碎石治疗 经内镜逆行胰胆管造影术 

分 类 号：R657.42[医药卫生—外科学]