中西医结合护理 (Feb 2023)
Effect of laser lithotripsy of giant bile duct stones under endoscopic retrograde cholangiopancreatography and nursing management (内镜逆行胰胆管造影术下胆总管巨大结石激光碎石效果观察及护理)
Abstract
Objective To compare the efficacy of dual-frequency dual-pulse laser lithotripsy under endoscopic retrograde cholangiopancreatography (ERCP) and traditional endoscopic mechanical lithotripsy in the treatment of patients with common bile duct stones, and summarize perioperative nursing measures. Methods From May 2018 to May 2022, the clinical data of 200 patients with common bile duct stones who underwent ERCP treatment and lithotripsy were retrospectively analyzed, of which 69 patients were treated with dual-frequency dual-pulse laser lithotripsy (Laser group) and 131 patients were treated with mechanical lithotripsy (Mechanical group), and the success rate of stone extraction, operation time, postoperative hospital stay time and complications of two groups of patients were compared. Results There was no significant difference in baseline data such as general conditions and preoperative clinical data between two groups (P＞0. 05). Neither neither Laser group nor Mechanical group had reported the perioperative death case. There were no significant difference in postoperative bleeding, postoperative pancreatitis and perforation complication rates in the two groups (P＞0. 05). The surgical time in the Laser group was significantly longer than that in the Mechanical group (P＜0. 05). The postoperative hospital stay was shorter in the Laser group than that in the Mechanical group(P＜0. 05), and the total complication rate and stone residue rate were lower in the Laser group than those in the Mechanical group (P＜0. 05). Conclusion The treatment of common bile duct stones by dual-frequency dual-pulse laser lithotripsy has better efficacy and lower complication rate than traditional surgical mechanical lithotripsy, but there is still room for improvement in the operation time. (目的 比较内镜逆行胰胆管造影术(ERCP)下双频双脉冲激光碎石与内镜下传统机械碎石治疗胆总管结石患者的效果, 总结护理经验。方法 回顾性分析2018年5月—2022年5月在北京中医药大学东方医院消化内镜中心行ERCP治疗并碎石的200例胆总管结石患者的临床资料, 其中69例患者采用双频双脉冲激光碎石术(激光组), 131例患者采用机械碎石(机械组)。比较两组患者的取石成功率、手术时间、术后住院时间、并发症等情况。结果 两组患者一般情况、术前临床资料等基线资料比较, 差异无统计学意义(P＞0. 05)。激光组和机械组均无围术期死亡患者。两组患者术后出血、术后胰腺炎、穿孔并发症率比较差异无统计学意义(P＞0. 05)。与机械组相比, 激光组的手术时间较长(P＜0. 05), 术后住院时间更短(P＜0. 05), 总并发症率和结石残留率更低(P＜0. 05)。结论 ERCP下双频双脉冲激光碎石治疗胆总管结石具有比传统手术机械碎石更好的效果及更低的并发症率, 但手术时间仍有改进的空间。)
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