目的：比较硬质胆道镜联合气压腔内碎石与纤维胆道镜治疗肝内胆管结石中的临床疗效。方法选取2012年6月至2015年6月就诊深圳市光明新区中心医院及协作单位的肝内胆管结石患者132例，采用随机数表法将其分为观察组和对照组，各66例。观察组患者经胆总管切开后，以硬质胆道镜探入胆道，并以气压腔内碎石，尽可能取尽结石；对照组以纤维胆道镜探查胆道，并以网篮取石，尽可能不遗漏结石。比较两组患者的手术疗效、并发症及结石复发情况。结果观察组的成功取石率明显优于对照组(84.8%vs 65.2%)，结石残留率明显低于对照组(15.2%vs 34.8%)，取石速度<40 min者所占百分比明显多于对照组(63.6%vs 43.9%)，差异均有统计学意义(P<0.05)；观察组发生胆漏发生率、出血发生率、胃肠道症状发生率分别为1.5%、1.5%6.1%，均明显低于对照组的12.1%、10.6%、20.0%，差异均有统计学意义(P<0.05)。观察组和对照组术后一年复发分别为3例、6例，术后三年复发分别为4例和10例，观察组结石复发情况显著优于对照组。结论采用硬质镜联合气压腔内碎石治疗肝内胆管结石可降低患者的残石率和复发率，减少胆道损伤，安全可靠，并发症发生率低，在外科治疗肝内胆管结石中有实际的临床意义。%Objective To compare the clinical effect of rigid choledochoscope combined with pneumatic litho-tripsy and fiberoptic choledochoscopy in the treatment of intrahepatic bile duct stones. Methods A total of 132 patients with intrahepatic bile duct stones in our hospital from June 2012 to June 2015 were selected as the study objects, which were randomly divided into the observation group and the control group by the random number table, with 66 patients in each group. In the observation group, patients were treated with rigid choledochoscope and pneumatic lithotripsy after in-cision of common bile duct, with the stones taken away as far as possible. Patients in the control group were treated with fiberoptic choledochoscopy and the stones were taken away by web baskets as far as possible. The clinical efficacy, com-plications and recurrence were compared between the two groups. Results The stone clearance rate in the observation group was significantly higher than that in the control group (84.8%vs 65.2%, P<0.01), and the residual rates of stone of the observation group was significantly lower than that of the control group (15.2%vs 34.8%, P<0.01). The percentage of patients with treatment duration of<40 min in the observation group was significantly higher than that in the control group (63.6% vs 43.9%, P<0.05). The incidences of bile leakage, bleeding, gastrointestinal symptoms in observation group were significantly lower than those in the control group (1.5%vs 12.1%, 1.5%vs 10.6%, 6.1%vs 20.0%, P<0.05). Three and 6 patients showed recurrence in one year in the observation group and the control group, and 4 and 10 patients showed recurrence in three years in the two groups, with the recurrence rate significantly lower in the observation group than the control group. Conclusion Applying rigid choledochoscope combined with pneumatic lithotripsy in the treat-ment of intrahepatic bile duct stones can reduce the residual rates of stone and recurrence rate, reduce the bile duct inju-ry, with low incidence of complications. It is safe and reliable, and has practical clinical significance in the surgical treat-ment of intrahepatic bile duct stones.
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