肾镜超声碎石术联合纤维胆道镜在肝胆管结石术后残留结石中的应用
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摘要
目的:探讨肾镜联合超声碎石术治疗肝内胆管术后残石的可行性及临床价值。方法:选取35例术后肝内胆管结石患者分为实验组18例和对照组17例,实验组应用肾镜及超声碎石术联合纤维胆道镜,对照组仅利用纤维胆道镜,均在预留T管或胆总管造瘘管基础上完成肝内胆管结石碎石取石手术,对比分析取石时间、结石取净率、不良事件发生率(术中、术后)。结果:所有患者均顺利完成手术。实验组平均费时47.83min,对照组62.76min,实验组较对照组更为高效;结石总清除率实验组为77.78%,对照组为70.59%,无明显差别;术中、术后不良事件发生率差异无显著性(P>0.05)。结论:肾镜超声碎石术联合纤维胆道镜治疗肝内胆管术后残石安全可靠,具有治疗效率高、手术时间短、结石取净率高、并发症少等优点,适合临床推广使用。
Objective:To investigate the clinical value and feasibilty of the application of nephroscope's ultrasonic lithotresis combined with choledochofiberscope in postoperative residual bile duct stones.Methods:We had collected 35 patients who suffered from postoperative residual bile duct stones,18 cases were included in experimental group with performed with nephroscope's ultrasonic lithotresis and choledochofiberscope together;17cases in control group which performed with choledochofiberscope only.Choledochus sinus tract from postoperation were determined to be the operation channel.The operation time,stone clearance rate,adverse event incidence rate(during and after operation),would be abserved and analysed.Results:All patients were successfully completed operation;experimental group costed 47.83 minutes in average to finish the operation,but the time from control group rised to 62.76 minutes,experimental group is more more efficiently(P<0.05);total clearance rate comed out with 74.29%,experimental group directed to77.78% and Control group fell on 70.59%(P>0.05),were no statistically significant;the adverse event incidence rate during and after operation also showed nonsignificant difference(P>0.05).Conclusion:The application of nephroscope's ultrasonic lithotresis combined with choledochofiberscope in postoperative residual bile duct stones is effective,feasible,environmentally friendly,which should be expanded to clinical treatment.
Objective:To investigate the clinical value and feasibilty of the application of nephroscope's ultrasonic lithotresis combined with choledochofiberscope in postoperative residual bile duct stones.Methods:We had collected 35 patients who suffered from postoperative residual bile duct stones,18 cases were included in experimental group with performed with nephroscope's ultrasonic lithotresis and choledochofiberscope together;17cases in control group which performed with choledochofiberscope only.Choledochus sinus tract from postoperation were determined to be the operation channel.The operation time,stone clearance rate,adverse event incidence rate(during and after operation),would be abserved and analysed.Results:All patients were successfully completed operation;experimental group costed 47.83 minutes in average to finish the operation,but the time from control group rised to 62.76 minutes,experimental group is more more efficiently(P<0.05);total clearance rate comed out with 74.29%,experimental group directed to77.78% and Control group fell on 70.59%(P>0.05),were no statistically significant;the adverse event incidence rate during and after operation also showed nonsignificant difference(P>0.05).Conclusion:The application of nephroscope's ultrasonic lithotresis combined with choledochofiberscope in postoperative residual bile duct stones is effective,feasible,environmentally friendly,which should be expanded to clinical treatment.
引文
[1]刘东京,张阳德,何剪太,等.纤维胆道镜在治疗胆管结石术后残余结石中的应用〔J〕.中国内镜杂志,2009,15(5):485-486.
[2]Amplatz S,Piazzi L,Felder M,et al.Extracorproeal shock wave lithotripsy for clearance of refractory bil duct stones〔J〕.Dig Liver Dis,2007,39(3):267-272.
[3]乔铁,黄万潮,何群芝,等.系列胆道镜的研发与应用〔J〕.中国医学装备,2012,9(1):13-18.
[4]Khan M,Qanri SJ,Nazir SS.Use of rigid nephroscope for laparoscopic common bile duet exploration-a single-center experience〔J〕.Wold J Surg,2010,34(4):784-790.
[5]黄炎松,柳建军,黄兴端,等.超声引导经皮肾镜气压弹道联合超碎石清石术治疗无积水肾结石〔J〕.医师进修杂志,2009,32(24):15-18.
[6]黄鹏,蔡旌槐,黄世旺,等.硬质肾镜联合超声碎石术治疗肝内胆管结石临床研究〔J〕.中国内镜杂志,2013,19(11):1207.
[7]王连福,孙树山,曹立瀛,等.超声碎石镜与纤维胆道镜联合应用治疗肝胆管结石(附82例报告)〔J〕.中华肝胆外科杂志,2000,6(3):207-210.
[8]曾祥勇,潘辅全,段珊,等.经皮肾镜联合超声碎石清石系统治疗术后胆道残留结石的临床应用〔J〕.中华普通外科杂志,2011,26(12):1054-1055.
[2]Amplatz S,Piazzi L,Felder M,et al.Extracorproeal shock wave lithotripsy for clearance of refractory bil duct stones〔J〕.Dig Liver Dis,2007,39(3):267-272.
[3]乔铁,黄万潮,何群芝,等.系列胆道镜的研发与应用〔J〕.中国医学装备,2012,9(1):13-18.
[4]Khan M,Qanri SJ,Nazir SS.Use of rigid nephroscope for laparoscopic common bile duet exploration-a single-center experience〔J〕.Wold J Surg,2010,34(4):784-790.
[5]黄炎松,柳建军,黄兴端,等.超声引导经皮肾镜气压弹道联合超碎石清石术治疗无积水肾结石〔J〕.医师进修杂志,2009,32(24):15-18.
[6]黄鹏,蔡旌槐,黄世旺,等.硬质肾镜联合超声碎石术治疗肝内胆管结石临床研究〔J〕.中国内镜杂志,2013,19(11):1207.
[7]王连福,孙树山,曹立瀛,等.超声碎石镜与纤维胆道镜联合应用治疗肝胆管结石(附82例报告)〔J〕.中华肝胆外科杂志,2000,6(3):207-210.
[8]曾祥勇,潘辅全,段珊,等.经皮肾镜联合超声碎石清石系统治疗术后胆道残留结石的临床应用〔J〕.中华普通外科杂志,2011,26(12):1054-1055.