CAJ | 학술논문

目的：探讨腹腔镜、胆道镜联合钬激光碎石在治疗难取性胆道结石的安全性和疗效。方法回顾我院2009年1月～2013年10月应用腹腔镜、胆道镜联合钬激光碎石治疗28例胆总管下端嵌顿性结石的患者。钬激光功率为1.5J/10Hz，光导纤维直径为200μm。光导纤维通过胆道镜工作通道，在直视下接触结石，将结石击碎后注水冲出或通过套石篮取出。结果28例患者结石均完全清除，无一例胆漏。术中胆道出血1例，经肾上腺素盐水冲洗后出血停止。27例患者得到随访，随访率96.4%。随访2～24个月，未见结石复发及胆道狭窄。结论腹腔镜、胆道镜联合激光碎石术具有直观、准确、疗效确切的特点，是治疗胆总管下段嵌顿性结石的一种安全、有效的新手段。
목적：탐토복강경、담도경연합화격광쇄석재치료난취성담도결석적안전성화료효。방법회고아원2009년1월～2013년10월응용복강경、담도경연합화격광쇄석치료28례담총관하단감돈성결석적환자。화격광공솔위1.5J/10Hz，광도섬유직경위200μm。광도섬유통과담도경공작통도，재직시하접촉결석，장결석격쇄후주수충출혹통과투석람취출。결과28례환자결석균완전청제，무일례담루。술중담도출혈1례，경신상선소염수충세후출혈정지。27례환자득도수방，수방솔96.4%。수방2～24개월，미견결석복발급담도협착。결론복강경、담도경연합격광쇄석술구유직관、준학、료효학절적특점，시치료담총관하단감돈성결석적일충안전、유효적신수단。
Objective To evaluate the safety and efficacy of holmium laser cholelithotripsy by laparoscopy combined with choledochofiberscopy for patients with complicated choledocholithiasis. Methods From January 2009 to October 2013,there were 28 cases with complicated choledocholithiasis undergoing laparoscopy and choledochofiberscopy for holmium laser cholelithotripsy. By holmium laser cholelithotripsy(1.5J/10Hz, 200um fiber),the stones were fragmented and extracted. Results The stones of 28 cases were completely removed without leading to bile leakage.Hemobilia in one case,improved after conservative treatment.27 cases were followed up for 2 to 24 months,in the rate of 96.4%.No recurrence of stones and biliary strictures. Conclusion Holmium laser cholelithotripsy by laparoscopy combined with choledochofiberscopy is intuitive,accurate and effective and accurate approach for complicated choledocholithiasis.