Department of Gastroenterology, Chengdu First People's Hospital, Chengdu, Sichuan Province, 610016, China.
Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan Province, 610072, China.
Sci Rep. 2020 Feb 13;10(1):2604. doi: 10.1038/s41598-020-58394-9.
Although postoperative cholangioscopy (POC) guided electrohydraulic lithotripsy (EHL) is considered to be a conventional technique for residual biliary calculi, its efficacy still needs to be improved to fit in the managemet of refractory calculi. This study evaluated the efficacy and safety of combined lithotripsy of mechanical clamping and electrohydraulics in fragmentation and removal of refractory calculi. Totally, 281 patients, who suffered from residual biliary calculi after hepatectomy and underwnet POC from August 2016 to June 2018 were involved. The first 128 patients were subjected to conventional EHL, and later consective 153 to combined lithotripsyof mechanical clamping and EHL. Perioperative data, technical information, treatment outcomes and follow-up results were collected. Clinical characteristics were statistically comparable (P > 0.05). The overall POC interventional sessions (2.0 ± 0.65 vs. 2.9 ± 1.21 sessions), average operating time (99.1 ± 34.88 vs. 128.6 ± 72.87 minutes), incidence of intraoperative hemobilia (4.58% vs. 10.93%), cholangitis (6.54% vs. 14.06%), postoperative complications (10.45% vs. 21.87%), T-tube retaining time after first POC (20.7 ± 5.35 vs. 28.1 ± 8.28 days), and treatment costs ($2375 ± 661.72 vs. $3456.7 ± 638.07) were significantly lower in the combined lithotripsy group than those in the EHL group (P < 0.05). There were no differences between the two groups in calculi recurrence at half-a year, or one year follow-up. In conclusion, combined lithotripsy of mechanical clamping and electrohydraulics can safely and effectively benefit postoperative patients along with refractory residual biliary calculi.
虽然术后胆管镜检查（POC）引导的电液压碎石术（EHL）被认为是治疗残余胆管结石的常规技术，但为了适应难治性结石的治疗，其疗效仍需提高。本研究评估了机械夹钳联合电液压碎石术碎裂和清除难治性结石的疗效和安全性。共有 281 例因肝切除术后残余胆管结石而行 POC 的患者于 2016 年 8 月至 2018 年 6 月纳入研究。前 128 例患者接受常规 EHL，随后连续 153 例患者接受机械夹钳联合 EHL 碎石术。收集围手术期数据、技术信息、治疗结果和随访结果。临床特征具有统计学可比性（P＞0.05）。POC 介入治疗次数（2.0±0.65 次 vs. 2.9±1.21 次）、平均手术时间（99.1±34.88 分钟 vs. 128.6±72.87 分钟）、术中出血发生率（4.58% vs. 10.93%）、胆管炎发生率（6.54% vs. 14.06%）、术后并发症发生率（10.45% vs. 21.87%）、首次 POC 后 T 管留置时间（20.7±5.35 天 vs. 28.1±8.28 天）、治疗费用（2375±661.72 美元 vs. 3456.7±638.07 美元）在联合碎石组均明显低于 EHL 组（P＜0.05）。两组术后半年及 1 年结石复发率无差异。总之，机械夹钳联合电液压碎石术可安全、有效地治疗术后难治性残余胆管结石患者。
