Objective To evaluate the safety and efficacy of holmium laser cholelithotripsy by laparoscopy combined with choledochofiberscopy for patients with complicated cholelithiasis. Methods The clinical data of 16 patients with complicated cholelithiasis, who received laparoscopy and choledochofiberscopy for holmium laser cholelithotripsy from March 2008 to March 2010 were reviewed retrospectively. The patients who had stones in both the common bile duct and gall bladder received laparoscopic cholecystectomy followed by holmium laser cholelithotripsy (1. 5 J/10 Hz, 400-μm fiber). The stones were then fragmented and extracted by irrigating or using a basket. Results Totally 22 stones were removed completed from the 16 patients in one session without leading to injury to the bile duct or biliary leakage. The patients were followed up for 5 to 30 months with a mean of 16 months, during which re-examination by B-ultrasonography or magnetic resonance cholangiopancreatography revealed no recurrence, residual stones or bile duct stricture. Conclusion Holmium laser cholelithotripsy by laparoscopy combined with choledochofiberscopy is a safe, effective, and accurate approach for complicated cholelithiasis.%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 2008年3月～2010年3月应用腹腔镜、胆道镜联合激光碎石治疗16例复杂性胆道结石,胆总管结石合并胆囊结石者先行腹腔镜胆囊切除术,再通过胆道镜工作通道,应用钬激光,功率为1.5 J/10 Hz,直径为400 μm光导纤维,在直视下接触结石,将胆总管结石击碎后注水冲出,或用取石篮套出. 结果 16例结石均一次性完全清除,碎石22枚.无胆道损伤、胆漏.16例术后随访5～30个月,平均16个月,腹部B超或磁共振胆胰管造影(magnetic resonance cholangiopancreatography,MRCP)检查未发现结石复发及残留,无胆道狭窄. 结论 腹腔镜、胆道镜联合激光碎石治疗胆道结石具有直观、准确、方便、疗效确切的特点,是治疗复杂性胆道结石的一种安全、有效的新手段.
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