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利用超薄上消化道内镜的直接经口胆管镜检查下的钬激光碎石用于需保留胆管结石的患者

发布日期:2014-1-29 12:40:24 文章来源:GIE 作者次数:1149
    利用超薄上消化道内镜的直接经口胆管镜检查下的钬激光碎石用于需保留胆管结石的患者
     
    背景
    使用超薄内窥镜的直接经口胆管镜检查(POC)可以直视胆管并允许治疗性干预。钬激光碎石术可有效地保留胆管结石,但它为保证安全有效的粉碎解释需要直接可视化。使用超薄内窥镜直接行经口胆管镜检查(POC)有利于钬激光碎石。
     
    目的
    评估使用超薄内窥镜的直接经口胆管镜检查下的钬激光碎石用于保留胆管结石的可行性,成功率及并发症。
     
    设计
    观测临床可行性研究。
     
    背景
    第三转诊中心。
     
    患者
    这项研究涉及13例保留胆管结石的患者,他们用传统碎石法(包括机械随时法)治疗失败。
     
    干预
    在利用超薄内窥镜的直接经口胆管镜检查下行钬激光碎石
     
    主要结果测量
    完成取石的成功率和与本手术有关的并发症。
     
    结果
    在利用超薄内窥镜的直接经口胆管镜检查下,有11例(共13例)成功接受了钬激光碎石术(84.6%)。虽然直接经口胆管镜检查成功了,但钬激光碎石术在2例患者中失败,其原因是结石的激光光纤定位不准确。除1例轻度胰腺炎外,没有手术相关的并发症。
     
    局限性
    患者数量少且没有与其他碎石系统进行比较。
     
    结论
    在利用超薄内窥镜的直接经口胆管镜检查下,钬激光碎石术是可行的,而且对保留胆管结石患者来说,是一种安全的内镜下治疗技术。
     
    缩写词:ND,掺钕;POC, 经口胆管镜检查;YAG,钇铝石榴石
     
     
     
     
    Holmium laser lithotripsy under direct peroral cholangioscopy by using an ultra-slim upper endoscope for patients with retained bile duct stones
    Background
    Direct peroral cholangioscopy (POC) by using an ultra-slim endoscope provides direct visualization of the bile duct and allows for therapeutic intervention. Holmium laser lithotripsy can be effective for retained bile duct stones, but it requires direct visualization during the procedure for safe and effective fragmentation. Direct POC by using an ultra-slim endoscope may facilitate holmium laser lithotripsy.
    Objective
    To evaluate the feasibility, success rates, and complications of holmium laser lithotripsy under direct POC by using an ultra-slim endoscope for retained bile duct stones.
    Design
    Observational clinical feasibility study.
    Setting
    Tertiary-care referral center.
    Patients
    This study involved 13 patients with retained bile duct stones whose treatment failed by a conventional lithotripsy method involving mechanical lithotripsy.
    Intervention
    Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope.
    Main Outcome Measurements
    Success rate of complete stone removal and procedure-related complications.
    Results
    Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope was successful in 11 of 13 patients (84.6%). Although direct POC was successful, holmium laser lithotripsy failed in 2 patients because of inaccurate targeting of the laser fiber to stones. There were no procedure-related complications except one case of mild pancreatitis.
    Limitations
    A small number of patients and no comparison with other lithotripsy systems.
    Conclusion
    Holmium laser lithotripsy under direct POC by using an ultra-slim endoscope was feasible and can be a safe endoscopic management method for retained bile duct stones.
    (作者:)
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