SpyGlass DS系统联合激光碎石法与常规分次治疗胆总管大结石的效果和安全性的对比分析

Comparative analysis of the efficacy and safety of SpyGlass DS system combined with laser lithotripsy and conventional fractional treatment of large calculus of common bile duct

摘要:

目的 比较SpyGlass DS系统激光碎石治疗术与内镜逆行胰胆管造影术（ERCP）下常规分次治疗胆总管大结石的安全性和有效性。方法 选取2021年11月－2023年10月该院行ERCP，术中提示胆总管大结石的患者（ > 2 cm）38例，分为实验组（n = 18）和对照组（n = 20），实验组使用SpyGlass DS系统联合激光碎石治疗，对照组使用分次治疗（第1次放入胆管支架，3个月后再次行常规ERCP下胆总管结石取出术）。比较两组患者术后结石清除成功率和ERCP术后并发症发生率；手术3个月后随访，并复查磁共振胆胰管成像（MRCP），以明确是否有胆总管残余结石。结果 实验组手术时间长于对照组，差异有统计学意义（P < 0.05）。两组患者取石成功率和近期并发症发生率比较，差异均无统计学意义（P > 0.05），实验组远期并发症发生率低于对照组，但差异无统计学意义（P = 0.090）。结论 由SpyGlass DS引导的激光碎石术治疗胆总管大结石的疗效确切，安全性高，术后结石复发率低。

Abstract:

Objective To compare the safety and efficacy of SpyGlass DS system laser lithotripsy and conventional fractional treatment under endoscopic retrograde cholangiopancreatography (ERCP) in treatment of large calculus of common bile duct.Method 38 patients with large calculus of common bile duct ( > 2 cm) during ERCP from November 2021 to October 2023 were selected and divided into experimental group (n = 18) and control group (n = 20). The experimental group was treated with SpyGlass DS system combined with laser lithotripsy. The patients in the control group were treated with split treatment (the first biliary stent was placed, and the calculus of common bile duct were removed under conventional ERCP again 3 months later). The success rate of stone clearance and the incidence of complications after ERCP were compared between the two groups. Magnetic resonance cholangiopancreatography (MRCP) was performed 3 months after surgery to determine whether there were residual calculus of common bile duct.Results The surgical time of the experimental group was longer than that of the control group, and the difference was statistically significant (P < 0.05). There was no significant difference in the stone clearance rate and the incidence of short-term complications between the two groups (P > 0.05). The incidence of long-term complications in the experimental group was lower than that in the control group, but the difference was not statistically significant (P = 0.090).Conclusion SpyGlass DS guided laser lithotripsy is effective and safe for the treatment of large calculus of common bile duct, with a low recurrence rate.