腹腔镜下胆道镜联合钬激光治疗肝内胆管结石的临床疗效研究.docVIP

精品论文 参考文献 腹腔镜下胆道镜联合钬激光治疗肝内胆管结石的临床疗效研究 淮安市淮阴医院普外二科 223300 【摘 要】目的：探讨腹腔镜下胆道镜联合钬激光在治疗难取性肝内胆管结石中的疗效、安全性以及临床应用价值。方法：50例难取性肝内结石患者随机分成钬激光组（n=25）和胆道镜组（n=25），比较两组术中手术时间、出血量、结石残留和术后胆管狭窄、胆漏以及并发症等情况。结果：两组均无手术死亡病例出现，无1例中转开腹手术。钬激光组在手术时间、出血量、结石残留以及并发症等方面均低于胆道镜组（Plt;0.05）；胆道镜组的胆管狭窄、胆漏和钬激光组相比（Pgt;0.05）。结论：腹腔镜下胆道镜联合钬激光治疗难取性肝内胆管结石是一种疗效确切、安全可靠的微创手术方式，可作为一种可行的手术方式在基层医院推广应用。 【关键词】腹腔镜；钬激光；临床疗效 Study of Clinical Effect of Intrahepatic Lithiasis by Laparoscopy With Choledochoscope and Holmium Laser ZHANG Hua-guo GUO Yun-hu YANG Ming XIE Guang-jun HU Zhi-feng BIAN Hu The Second Department of General Surgery，the Huai Yin Hospital of Huairsquo;an City，JiangSu，223300 【Abstract】Objective To explore the effects，safety and clinical values in the treatment of intrahepatic lithiasis by laparoscopy with choledochoscope and holmium laser.Methods 50 patients with refractory intrahepatic stones were randomly divided into two groups of holmium laser group and choledochoscope group with 25 cases in each.Compared the two groups patientsrsquo;difference between operative time，blood loss，residual stones in operation and bile duct stenosis，bile leakage，complication after operation.Results There were no death occurred in both groups and no one case were converted to open operation during the procedure.The operative time，blood loss，residual stones and complication in holmium laser group were lower than those in choledochoscope group（Plt;0.05）.There were no significant differences between the number of bile duct stenosis and bile leakage in the two groups（Pgt;0.05）.Conclusion Intrahepatic lithiasis by laparoscopy with choledochoscope and holmium laser was safe and effective as minimally invasive surgery，which was worth being widely used in primary hospitals. 【Key words】laparoscopic；holmium laser；clinical effects 胆管结石在我国属于较为常见的胆道疾病之一，多数进行手术治疗，以往手术取石均难以清除干净，术后残石率为30.4%[1]，胆道结石的处理至今仍是肝胆外科的难题之一。随着胆道镜技术的发展，为治疗肝内胆管结石提供了新的临床途径[2]。当前钬激光是众多医用激光中较新的一种，已广泛应用于泌尿外科等领域，正逐渐用于胆道结石的碎石治疗[3]。淮安市淮阴医院普外二科根据自身在利用钬激光治疗难取