摘要
目的探讨钬激光联合胆道镜在治疗难取性肝胆管结石的应用价值。方法回顾性分析20例胆石症患者通过胆道镜工作通道,应用钬激光功率为1.0/10 HZ直径为400μm光导纤维,在直视下接触结石,将肝内外胆管结石击碎后注水冲出或用取石篮套出。结果20例取石成功,取石时间10～15 min,平均20 min。1例术后残余结石因窦道过细,胆道镜不能通过,只能开腹手术,术中用钬激光碎石成功。术后无胆道出血、胆漏。术后随访6个月,腹部B超或经"T"管胆道造影检查,未发现结石复发及残留,无胆道狭窄。结论钬激光联合胆道镜治疗难取性肝胆管结石,具有创伤小、恢复快、碎石确切、安全有效等优点,为治疗肝胆管结石开辟了一条新的治疗途径。
Objective To explore the value of clinical application of holmium laser combined with choledochoscopy for treatment of refractory intrahepatic and extrahepetic stones.Methods Under choledochoscopy,400 μm fiber holmium laser lithotripsy of refractory intrahepatic and extrahepatic stones were performed.The setting on the laser were 1.0 J and 10 Hz.The choledochoscopy were used to access the refractory intrahepatic and extrahepatic stones.The stones were fragmented and the extracted with irrigation or by using a basked.Results The stones were successfully removed in all 20 cases.The duration of operation was 1050 min（mean,20 min）.Out of the 20 cases,one was completed by using holmium laser to fragmente the stones in the operation on the stomache as the residual stones can＇be extracted with the stricuture of of the sinus,so the choledochoscopy can′t get through.No bile duct bleeding or biliary leakage occurred after operation.Follow-up was conducted in all 20 cases for 6 months.B-ultrasonography or intvaoperative cholangiography found no recurrent or residual stones or bile duct stricuture.Conclusion Holmium laser lithotripsy combined with choledochoscopy in the treatment of refractory intrahepatic and extrahepastic bile duct stones has advantages of minimal invasion rapid recovery,satisfactory lithotripsy effects and high reliability,which offers a new ways of the treatment of introhepatic and extrahepatic bile duct stones.
出处
《肝胆外科杂志》
2010年第2期114-116,共3页
Journal of Hepatobiliary Surgery
关键词
钬激光
胆道镜
肝胆管结石
holmium laser
choledochofiberscopy
introhepatic and extrahepatic bile duct stones
