经口胆胰管镜下能量碎石用于胆总管巨大结石治疗的临床研究

Clinical Study on Peroral Cholangioscopy-Guided Lithotripsy for Large Common Bile Duct Stones

摘要:

比较经口胆胰管镜下激光和液电两种能量碎石治疗胆总管巨大结石的临床疗效及安全性，回顾性纳入吉林市人民医院消化中心2022年1月至2025年2月因胆总管巨大结石行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography，ERCP)联合经口胆胰管镜下能量碎石的患者，根据能量碎石的方式不同，分为激光组和液电组。主要观察指标为技术成功率、手术时间、短期并发症发生率，次要观察指标为治疗前后临床资料及术后处理。研究纳入69例患者，其中激光组40例，和液电组29例，两组间基线资料比较差异无统计学意义(P>0.05)。技术成功率方面，激光组及液电组均为100.0%，差异无统计学意义（P>0.05）。液电组ERCP操作时间53.00 (43.00, 70.00)min，能量碎石时间23.00 (17.00, 39.00)min；激光组ERCP操作时间68.00 (50.00, 80.50)min，能量碎石时间35.00 (27.75, 40.75)min；液电组ERCP操作时间短于激光组(Z=2.073，P=0.038)，能量碎石时间短于激光组(Z=2.262，P=0.024)。术后短期并发症中，术中及术后出血发生率激光组和液电组分别为0.0%(0/40)和17.2%(5/29)，液电组出血发生率高于激光组（P=0.011）；胰腺炎、胆囊炎、穿孔发生率两组间差异均无统计学意义（P>0.05）。术后胆道引流激光组37例，液电组26例。经口胆胰管镜下能量碎石治疗胆总管巨大结石中，液电碎石效果高于与激光碎石技术成功率相当，液电碎石操作时间较激光碎石时间少，但液电碎石安全性低于激光碎石，可根据临床病例选择具体的碎石方式。

Abstract:

To evaluate the clinical efficacy and safety of laser and electrohydraulic lithotripsy (EHL) under peroral cholangioscopy for treating large common bile duct (CBD) stones, a retrospective study was conducted on 69 patients with large CBD stones treated with endoscopic retrograde cholangiopancreatography (ERCP) combined with peroral cholangioscopy-guided lithotripsy at the Digestive Center of Jilin City People"s Hospital from January 2022 to February 2025. Patients were divided into a laser group and an EHL group based on the lithotripsy method used. Primary outcomes included technical success rate, procedure time, and incidence of short-term complications. Secondary outcomes included clinical data before and after treatment, and postoperative management. The laser group comprised 40 patients and the EHL group 29 patients. There were no statistically significant differences in baseline characteristics between the two groups (P > 0.05). Regarding the technical success rate, both the laser lithotripsy group and the electrohydraulic lithotripsy group achieved technical success in 100.0% of cases, with no statistically significant difference (P > 0.05). In the electrohydraulic lithotripsy group, the ERCP procedure time was 53.00 (43.00, 70.00) min, and the energy lithotripsy time was 23.00 (17.00, 39.00) min; in the laser lithotripsy group, the ERCP procedure time were 68.00 (50.00, 80.50) min, and the energy lithotripsy time was 35.00 (27.75, 40.75) min. Both the ERCP procedure time and energy lithotripsy time were significantly shorter in the electrohydraulic lithotripsy group than in the laser lithotripsy group (Z = 2.073, P = 0.038; Z = 2.262, P = 0.024, respectively). For short-term postoperative complications, the incidences of intraoperative and postoperative hemorrhage were 0.0% (0/40) in the laser lithotripsy group and 17.2% (5/29) in the electrohydraulic lithotripsy group, with the latter exhibiting a significantly higher hemorrhage incidence (P = 0.011). No statistically significant differences were observed between the two groups in the incidences of pancreatitis, cholecystitis, and perforation (P > 0.05). Postoperative biliary drainage was performed in 37 cases in the laser lithotripsy group and 26 cases in the electrohydraulic lithotripsy group. In the treatment of giant common bile duct stones via energy lithotripsy under peroral cholangiopancreatoscopy, electrohydraulic lithotripsy and laser lithotripsy yielded comparable technical success rates. Electrohydraulic lithotripsy was associated with shorter procedural durations but a less favorable safety profile compared with laser lithotripsy. Therefore, the choice of lithotripsy modality should be tailored to the clinical characteristics.