Article(id=1317885750264320332, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, articleNumber=null, orderNo=null, doi=10.12449/JCH260823, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1771948800000, receivedDateStr=2026-02-25, revisedDate=null, revisedDateStr=null, acceptedDate=1774540800000, acceptedDateStr=2026-03-27, onlineDate=1792138047995, onlineDateStr=2026-10-16, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792138047995, onlineIssueDateStr=2026-10-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792138047995, creator=13701087609, updateTime=1792138047995, updator=13701087609, issue=Issue{id=1317885672153797495, tenantId=1146029695717560320, journalId=1316781422847033486, year='2026', volume='42', issue='8', pageStart='1745', pageEnd='2000', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=1, specialIssue=null, createTime=1792138029373, creator='13701087609', updateTime=1792138608261, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1317888100290900262, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1317888100290900263, tenantId=1146029695717560320, journalId=1316781422847033486, issueId=1317885672153797495, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1902, endPage=1907, ext={EN=ArticleExt(id=1317885750604058958, articleId=1317885750264320332, tenantId=1146029695717560320, journalId=1316781422847033486, language=EN, title=Clinical application of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy for large common bile duct stones, columnId=1317885750486618445, journalTitle=Journal of Clinical Hepatology, columnName=Biliary Disease, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the safety and efficacy of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy (EHL).

Methods

A retrospective analysis was performed for the clinical data of 60 patients with large common bile duct stones who were admitted to Department of Gastroenterology,Jilin People’s Hospital,from May 1,2023 to January 31,2026,and according to the treatment method,the patients were divided into transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group and peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group,with 30 patients in each group. The two groups were compared in terms of the rate of successful single-session stone fragmentation and removal,procedural time,duration of electrohydraulic lithotripsy,clinical success rate,and complications. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.

Results

Compared with the peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group,the transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group had a significantly higher technical success rate (83.33% vs 60.00%,χ2=4.022,P=0.045) and significantly shorter procedural time [46.00 (42.25 — 49.00) min vs 54.50 (42.00 — 65.00) min,Z=2.012,P=0.044] and duration of electrohydraulic lithotripsy [8.00 (6.25 — 11.75) min vs 13.50 (9.25 — 17.75) min,Z=2.749,P=0.006]. Both groups achieved a clinical success rate of 100%,with no significant difference in the incidence rate of complications (P>0.05).

Conclusion

Transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy has a high rate of successful single-session stone fragmentation and removal and a short procedural time,with good safety and efficacy,and therefore,it holds promise for clinical application.

, authors=Liying Tao, Hongguang Wang, Qingmei Guo, Chong Pang, Yundong Shi, Sijie Guo, Tianjiao Jia, Yan Chen, Jiani Zhou, Shu Che, authorsList=Liying Tao, Hongguang Wang, Qingmei Guo, Chong Pang, Yundong Shi, Sijie Guo, Tianjiao Jia, Yan Chen, Jiani Zhou, Shu Che, authorCompany=null, correspAuthors=Hongguang Wang, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1317885753733009746, articleId=1317885750264320332, tenantId=1146029695717560320, journalId=1316781422847033486, language=CN, title=透明帽辅助经口胆胰管镜直视液电碎石在胆总管巨大结石治疗中的作用, columnId=1317885750675362127, journalTitle=临床肝胆病杂志, columnName=胆道疾病, runingTitle=null, highlight=null, articleAbstract=
目的

探讨透明帽辅助经口胆胰管镜直视液电碎石的安全性和有效性。

方法

回顾性分析2023年5月1日—2026年1月31日吉林市人民医院消化内科收治的60例胆总管巨大结石患者的临床资料,根据治疗方式分为透明帽辅助经口胆胰管镜直视液电碎石组和经口胆胰管镜直视液电碎石组,每组各30例。比较两组患者的手术一次性完整碎石取石技术成功率、手术操作时间、液电碎石时间、手术临床成功率、并发症等指标。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher精确概率法。

结果

与经口胆胰管镜直视液电碎石组相比,透明帽辅助经口胆胰管镜直视液电碎石组的技术成功率(83.33% vs 60.00%,χ2=4.022,P=0.045)显著升高,手术操作时间[46.00(42.25~49.00)min vs 54.50(42.00~65.00)min,Z=2.012,P=0.044]、液电碎石时间[8.00(6.25~11.75)min vs 13.50(9.25~17.75)min,Z=2.749,P=0.006]显著缩短;两组的手术临床成功率均为100%,并发症的发生率差异均无统计学意义(P值均>0.05)。

结论

透明帽辅助经口胆胰管镜直视液电碎石的一次性完整碎石取石技术成功率高,操作时间缩短,且安全有效,值得临床进一步推广。

, authors=陶丽莹, 王宏光, 郭庆梅, 庞崇, 施云东, 郭思捷, 贾天娇, 陈岩, 周佳妮, 车舒, authorsList=陶丽莹, 王宏光, 郭庆梅, 庞崇, 施云东, 郭思捷, 贾天娇, 陈岩, 周佳妮, 车舒, authorCompany=null, correspAuthors=王宏光, authorNote=

作者贡献声明

陶丽莹负责论文课题设计,收集数据,分析资料,撰写论文;郭庆梅、庞崇、施云东、郭思捷、贾天娇、陈岩、周佳妮和车舒负责收集和整理数据;王宏光负责修改论文,指导撰写文章并最后定稿。

, correspAuthorsNote=
王宏光, (ORCID:0000-0003-1100-9804)
Wang Hongguang, (ORCID:0000-0003-1100-9804)
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DOI: 10.3760/cma.j.cn115610-20240129-00048., articleTitle=Focus and controversy on the diagnosis and therapy of hepatolithiasis, refAbstract=null), Reference(id=1317885764365570479, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, doi=null, pmid=null, pmcid=null, year=2025, volume=57, issue=01, pageStart=E653, pageEnd=E655, url=null, language=null, rfNumber=19, rfOrder=23, authorNames=Hu S S, Liu X G, Hou J, journalName=Endoscopy, refType=null, unstructuredReference=Hu S S, Liu X G, Hou J, et al. The guidewire-guided endoscopic retrograde direct cholangioscopy facilitating the difficult biliary cannulation of small papilla[J]. Endoscopy, 2025, 57(S 01): E653-E655. 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DOI: 10.1055/a-2665-7090., articleTitle=Double the efficacy, half the effort: Columnar transparent cap-assisted cholangioscopy for bile duct stone extraction, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1317885753930142035, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, xref=null, ext=[AuthorCompanyExt(id=1317885753938530644, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, companyId=1317885753930142035, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Gastroenterology,Jilin People’s Hospital,Jilin,Jilin 132001,China), AuthorCompanyExt(id=1317885753946919253, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, companyId=1317885753930142035, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=吉林市人民医院消化内科,吉林 吉林 132001)])], figs=[ArticleFig(id=1317885759068164496, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=EN, label=Figure 1, caption=Intraoperative procedure of direct visualization electrohydraulic lithotripsy for giant common bile duct stones via peroral cholangiopancreatoscopy assisted by a conical transparent cap, figureFileSmall=gAtFBQJKYfx4xYlhgv/CZA==, figureFileBig=V8cD2gq6rGl4TdUoEARhhQ==, tableContent=null), ArticleFig(id=1317885759303045521, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=CN, label=图1, caption=锥形透明帽辅助经口胆道镜直视液电治疗胆总管巨大结石手术过程

注:a,术前超声内镜评估胆总管巨大结石直径及胆管宽度;b,十二指肠乳头插管;c,十二指肠乳头括约肌球囊扩张术;d,经口胆道镜插入胆管内直视观察胆总管巨大结石;e,经口胆道镜先端佩戴锥形透明帽;f,液电光纤位于锥形透明帽内,锥形透明帽远端固定结石,液电对准结石中心进行碎石;g,液电碎石后胆总管巨大结石被击碎;h,碎石取石后再次进入经口胆道镜观察胆管内无结石残留;i,导管内留置鼻胆管引流,十二指肠乳头上方应用和谐夹预防出血、穿孔。

, figureFileSmall=gAtFBQJKYfx4xYlhgv/CZA==, figureFileBig=V8cD2gq6rGl4TdUoEARhhQ==, tableContent=null), ArticleFig(id=1317885759730864530, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=EN, label=Table 1, caption=

Comparison of preoperative clinical data between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
指标经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)统计值P值
年龄(岁)69.87±14.2076.20±12.63t=-1.8250.073
性别[例(%)]χ2=1.0710.301
男14(46.67)18(60.00)
女16(53.33)12(40.00)
高血压[例(%)]11(36.67)14(46.67)χ2=0.6170.432
WBC(×109/L)8.00(6.10~12.00)8.65(5.62~11.30)Z=0.2550.798
CRP(mg/L)80.48(38.45~132.25)56.40(21.50~100.91)Z=0.8780.380
TBil(μmol/L)47.60(25.55~103.72)58.30(27.80~91.00)Z=0.0940.925
DBil(μmol/L)34.70(16.60~73.83)43.00(15.30~77.10)Z=-0.0280.977
结石直径(mm)17.32±3.0115.83±4.03t=1.6160.111
), ArticleFig(id=1317885759844110739, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=CN, label=表1, caption=

两组患者术前临床资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)统计值P值
年龄(岁)69.87±14.2076.20±12.63t=-1.8250.073
性别[例(%)]χ2=1.0710.301
男14(46.67)18(60.00)
女16(53.33)12(40.00)
高血压[例(%)]11(36.67)14(46.67)χ2=0.6170.432
WBC(×109/L)8.00(6.10~12.00)8.65(5.62~11.30)Z=0.2550.798
CRP(mg/L)80.48(38.45~132.25)56.40(21.50~100.91)Z=0.8780.380
TBil(μmol/L)47.60(25.55~103.72)58.30(27.80~91.00)Z=0.0940.925
DBil(μmol/L)34.70(16.60~73.83)43.00(15.30~77.10)Z=-0.0280.977
结石直径(mm)17.32±3.0115.83±4.03t=1.6160.111
), ArticleFig(id=1317885759927996820, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=EN, label=Table 2, caption=

Comparison of surgical-related indicators between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
指标经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)统计值P值
技术成功[例(%)]18(60.00)25(83.33)χ2=4.0220.045
临床成功[例(%)]30(100.00)30(100.00)χ2=0.000>0.05
ERCP操作时间(min)54.50(42.00~65.00)46.00(42.25~49.00)Z=2.0120.044
液电碎石时间(min)13.50(9.25~17.75)8.00(6.25~11.75)Z=2.7490.006
∆WBC(×109/L)-1.20(-2.83~1.95)0.30(-2.35~1.60)Z=-0.8800.379
∆NEU(%)0.03(-0.06~0.15)0.05(0.00~0.12)Z=-1.0570.290
∆CRP(mg/L)-27.79±65.89-12.92±52.86t=-0.8050.425
∆TBil(μmol/L)-40.60(-82.80~-13.45)-43.10(-54.98~-17.50)Z=-0.2820.778
∆DBil(μmol/L)-41.25±34.09-34.16±23.68t=-0.7010.488
), ArticleFig(id=1317885760003494293, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=CN, label=表2, caption=

两组手术相关指标比较

, figureFileSmall=null, figureFileBig=null, tableContent=
指标经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)统计值P值
技术成功[例(%)]18(60.00)25(83.33)χ2=4.0220.045
临床成功[例(%)]30(100.00)30(100.00)χ2=0.000>0.05
ERCP操作时间(min)54.50(42.00~65.00)46.00(42.25~49.00)Z=2.0120.044
液电碎石时间(min)13.50(9.25~17.75)8.00(6.25~11.75)Z=2.7490.006
∆WBC(×109/L)-1.20(-2.83~1.95)0.30(-2.35~1.60)Z=-0.8800.379
∆NEU(%)0.03(-0.06~0.15)0.05(0.00~0.12)Z=-1.0570.290
∆CRP(mg/L)-27.79±65.89-12.92±52.86t=-0.8050.425
∆TBil(μmol/L)-40.60(-82.80~-13.45)-43.10(-54.98~-17.50)Z=-0.2820.778
∆DBil(μmol/L)-41.25±34.09-34.16±23.68t=-0.7010.488
), ArticleFig(id=1317885760129323414, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=EN, label=Table 3, caption=

Comparison of complications between the two groups

, figureFileSmall=null, figureFileBig=null, tableContent=
项目经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)
出血[例(%)]0(0.00)1(3.33)
胆管炎[例(%)]3(10.00)0(0.00)
穿孔[例(%)]0(0.00)0(0.00)
胰腺炎[例(%)]7(23.33)4(13.33)
胆管壁损伤[例(%)]3(10.00)0(0.00)
高淀粉酶血症[例(%)]0(0.00)2(6.67)
), ArticleFig(id=1317885760213209495, tenantId=1146029695717560320, journalId=1316781422847033486, articleId=1317885750264320332, language=CN, label=表3, caption=

两组并发症情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
项目经口胆胰管镜直视液电碎石组(n=30)透明帽辅助经口胆胰管镜直视液电碎石组(n=30)
出血[例(%)]0(0.00)1(3.33)
胆管炎[例(%)]3(10.00)0(0.00)
穿孔[例(%)]0(0.00)0(0.00)
胰腺炎[例(%)]7(23.33)4(13.33)
胆管壁损伤[例(%)]3(10.00)0(0.00)
高淀粉酶血症[例(%)]0(0.00)2(6.67)
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透明帽辅助经口胆胰管镜直视液电碎石在胆总管巨大结石治疗中的作用
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陶丽莹 , 王宏光 , 郭庆梅 , 庞崇 , 施云东 , 郭思捷 , 贾天娇 , 陈岩 , 周佳妮 , 车舒
临床肝胆病杂志 | 胆道疾病 2026,42(8): 1902-1907
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临床肝胆病杂志 |胆道疾病 2026 , 42 (8) : 1902 -1907
透明帽辅助经口胆胰管镜直视液电碎石在胆总管巨大结石治疗中的作用
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陶丽莹, 王宏光 , 郭庆梅, 庞崇, 施云东, 郭思捷, 贾天娇, 陈岩, 周佳妮, 车舒
作者信息
  • 吉林市人民医院消化内科,吉林 吉林 132001
通讯作者:
王宏光, (ORCID:0000-0003-1100-9804)
Wang Hongguang, (ORCID:0000-0003-1100-9804)
作者简介:

作者贡献声明

陶丽莹负责论文课题设计,收集数据,分析资料,撰写论文;郭庆梅、庞崇、施云东、郭思捷、贾天娇、陈岩、周佳妮和车舒负责收集和整理数据;王宏光负责修改论文,指导撰写文章并最后定稿。

Clinical application of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy for large common bile duct stones
Liying Tao, Hongguang Wang , Qingmei Guo, Chong Pang, Yundong Shi, Sijie Guo, Tianjiao Jia, Yan Chen, Jiani Zhou, Shu Che
Affiliations
  • Department of Gastroenterology,Jilin People’s Hospital,Jilin,Jilin 132001,China
出版时间: 2026-08-25 doi: 10.12449/JCH260823
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目的

探讨透明帽辅助经口胆胰管镜直视液电碎石的安全性和有效性。

方法

回顾性分析2023年5月1日—2026年1月31日吉林市人民医院消化内科收治的60例胆总管巨大结石患者的临床资料,根据治疗方式分为透明帽辅助经口胆胰管镜直视液电碎石组和经口胆胰管镜直视液电碎石组,每组各30例。比较两组患者的手术一次性完整碎石取石技术成功率、手术操作时间、液电碎石时间、手术临床成功率、并发症等指标。计量资料两组间比较采用成组t检验或Mann-Whitney U检验。计数资料两组间比较采用χ2检验或Fisher精确概率法。

结果

与经口胆胰管镜直视液电碎石组相比,透明帽辅助经口胆胰管镜直视液电碎石组的技术成功率(83.33% vs 60.00%,χ2=4.022,P=0.045)显著升高,手术操作时间[46.00(42.25~49.00)min vs 54.50(42.00~65.00)min,Z=2.012,P=0.044]、液电碎石时间[8.00(6.25~11.75)min vs 13.50(9.25~17.75)min,Z=2.749,P=0.006]显著缩短;两组的手术临床成功率均为100%,并发症的发生率差异均无统计学意义(P值均>0.05)。

结论

透明帽辅助经口胆胰管镜直视液电碎石的一次性完整碎石取石技术成功率高,操作时间缩短,且安全有效,值得临床进一步推广。

胆总管结石病  /  碎石术  /  透明帽  /  治疗结果
Objective

To investigate the safety and efficacy of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy (EHL).

Methods

A retrospective analysis was performed for the clinical data of 60 patients with large common bile duct stones who were admitted to Department of Gastroenterology,Jilin People’s Hospital,from May 1,2023 to January 31,2026,and according to the treatment method,the patients were divided into transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group and peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group,with 30 patients in each group. The two groups were compared in terms of the rate of successful single-session stone fragmentation and removal,procedural time,duration of electrohydraulic lithotripsy,clinical success rate,and complications. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.

Results

Compared with the peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group,the transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy group had a significantly higher technical success rate (83.33% vs 60.00%,χ2=4.022,P=0.045) and significantly shorter procedural time [46.00 (42.25 — 49.00) min vs 54.50 (42.00 — 65.00) min,Z=2.012,P=0.044] and duration of electrohydraulic lithotripsy [8.00 (6.25 — 11.75) min vs 13.50 (9.25 — 17.75) min,Z=2.749,P=0.006]. Both groups achieved a clinical success rate of 100%,with no significant difference in the incidence rate of complications (P>0.05).

Conclusion

Transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy has a high rate of successful single-session stone fragmentation and removal and a short procedural time,with good safety and efficacy,and therefore,it holds promise for clinical application.

Choledocholithiasis  /  Lithotripsy  /  Transparent Cap  /  Treatment Outcome
陶丽莹, 王宏光, 郭庆梅, 庞崇, 施云东, 郭思捷, 贾天娇, 陈岩, 周佳妮, 车舒. 透明帽辅助经口胆胰管镜直视液电碎石在胆总管巨大结石治疗中的作用. 临床肝胆病杂志, 2026 , 42 (8) : 1902 -1907 . DOI: 10.12449/JCH260823
Liying Tao, Hongguang Wang, Qingmei Guo, Chong Pang, Yundong Shi, Sijie Guo, Tianjiao Jia, Yan Chen, Jiani Zhou, Shu Che. Clinical application of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy for large common bile duct stones[J]. Journal of Clinical Hepatology, 2026 , 42 (8) : 1902 -1907 . DOI: 10.12449/JCH260823
胆总管结石临床表现为腹痛、发热及黄疸,并可导致急性胆源性胰腺炎、急性梗阻性化脓性胆管炎、感染性休克等急症,严重时甚至危及患者生命。胆总管巨大结石是指直径≥1.5 cm的结石,目前,其治疗方式包括传统外科手术及内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP),但内镜下取石可能会面临网篮不够大难以完全套取、机械碎石成功率低等问题,从而增加取石难度及风险[1-2]。随着内镜设备的不断改进,越来越多的新技术被应用于胆总管巨大结石的碎石治疗。有研究表明,经口胆胰管镜直视下液电碎石或激光碎石等能量碎石的方式,已在临床中得到广泛应用,并显著增加了胆总管巨大结石的取石成功率[3-5]。尽管液电碎石效果良好,但在操作过程中可能会发生胆管壁损伤、胆瘘、出血、穿孔等不良事件[6]。既往研究表明,在经口胆胰管镜先端应用透明帽,并联合能量碎石,可将能量光纤先端保护于透明帽中,既有助于固定结石,又能减少对胆管壁的损伤[7],然而,目前多为个案报道。本研究回顾性分析透明帽辅助经口胆胰管镜直视液电碎石与经口胆胰管镜直视液电碎石治疗胆总管巨大结石患者的临床资料,比较透明帽辅助直视碎石治疗方式的安全性及有效性。
回顾性分析2023年5月1日—2026年1月31日本院消化内科收治的胆总管巨大结石患者的临床资料,根据治疗方式分为透明帽辅助经口胆胰管镜直视液电碎石组和经口胆胰管镜直视液电碎石组。纳入标准:(1)通过计算机体层成像或磁共振胰胆管成像检查,术前诊断为胆总管结石,且结石直径≥15 mm;(2)术前均未经过胃肠、胆道手术治疗;(3)知晓研究内容,并自愿签署知情同意书;(4)无ERCP治疗史,无影响凝血功能的疾病及用药史。排除标准:(1)合并其他胆道疾病,如肝内胆管结石、胆管狭窄等;(2)有上消化道重建手术史;(3)存在多脏器功能衰竭;(4)合并胆道肿瘤。所有手术均由同一医疗组完成。
常规行血常规、凝血功能、生化指标等检测,完善心电图、肺部计算机体层成像及心脏彩超,以评估心肺功能。纳入患者均符合手术适应证,排除手术禁忌证,并签署手术知情同意书。术前8 h禁食、禁水,且在全身静脉麻醉下进行操作。
十二指肠镜:日本奥林巴斯,型号TJF260V;经口胆胰管镜:中国南微医学,型号eyeMAX洞察CDS22001;超声内镜:日本富士,型号SU-9000;液电碎石机:中国西安远鸿,型号iMES-I-D;透明帽:中国南微医学,型号洞察帽(锥形款)VC34037。
(1)患者取左侧卧位,采用超声内镜检查明确胆总管结石位置、数量及大小,胆总管走形及宽度;(2)更换十二指肠镜,抵达十二指肠降段,拉直镜身进行乳头常规插管;(3)回抽导丝有胆汁流出,确认进入胆总管后对乳头进行切开、扩张;(4)经口胆胰管镜进入胆管内,观察胆总管巨大结石,尽量抽吸胆汁以确保视野更加清晰;(5)退出经口胆胰管镜,将液电光纤预置于经口胆胰管镜的工作管道内,再次将经口胆胰管镜插入胆总管;(6)液电光纤对准胆总管巨大结石进行直视碎石,碎石过程需在水下完成;(7)逐步将结石完全击碎后,应用网篮取石,遵循应取尽取的原则,力争将结石一次性完全取净;(8)取石后再次进入经口胆胰管镜,确认胆管内无结石残留;(9)最后将导丝留置于胆道内,在导丝引导下置入鼻胆管或双猪尾支架进行引流。
基本过程同上,仅在步骤(5)有所不同:在经口胆胰管镜光纤导管前端佩戴透明帽后,再将液电光纤预置于经口胆胰管镜的工作管道内,随后将佩戴透明帽的经口胆胰管镜插入胆道内,直视下将液电光纤略伸出透明帽或使其与透明帽远端平齐,对准结石进行碎石(图1)。
(1)手术相关指标:①技术成功率:一次性完成胆总管巨大结石碎石及取石的患者比例;②ERCP操作时间:从十二指肠镜插入口腔至取石后将十二指肠镜退出口腔的时间;③液电碎石时间:经口胆胰管镜进入胆管内进行液电碎石至碎石结束后退出胆道的时间;④手术临床成功率:通过碎石治疗后发热、腹痛等临床症状缓解,且无转入外科行手术或经皮经肝胆管穿刺引流治疗等情况的患者比例。(2)手术后恢复情况:术后生化指标等。(3)手术并发症:出血、穿孔、胆管炎、胆管损伤、胰腺炎、高淀粉酶血症等发生情况。
采用R 4.4.1软件对数据进行处理与分析。正态分布的计量资料以x¯±s表示,两组间比较采用成组t检验;非正态分布的计量资料以M(P25~P75)表示,两组间比较采用Mann-Whitney U检验。计数资料组间比较采用χ2检验或Fisher精确概率法。P<0.05为差异有统计学意义。
共纳入60例胆总管巨大结石患者,其中透明帽辅助经口胆胰管镜直视液电碎石组和经口胆胰管镜直视液电碎石组各30例。两组患者性别、年龄、基础疾病、生化指标等临床资料比较,差异均无统计学意义(P值均>0.05)(表1)。
透明帽辅助经口胆胰管镜直视液电碎石组与经口胆胰管镜直视液电碎石组在技术成功率、ERCP操作时间、液电碎石时间方面比较,差异均有统计学意义(P值均<0.05);两组的手术临床成功率均为100%;术前与术后白细胞、C反应蛋白、中性粒细胞百分比、总胆红素及直接胆红素变化值比较,差异均无统计学意义(P值均>0.05)(表2)。
透明帽辅助经口胆胰管镜直视液电碎石组一次性完整取石技术成功率为83.33%(25/30),其余5例患者因高龄、心肺功能欠佳及术中血氧维持不理想,先行胆道内留置引流,择期行二次取石。经口胆胰管镜直视液电碎石组一次性完整取石技术成功率仅为60.00%,较前者技术成功率显著下降。
两组患者术后并发症比较,差异均无统计学意义(P值均>0.05)(表3)。透明帽辅助经口胆胰管镜直视液电碎石组有1例出血,为十二指肠乳头切开后迟发性出血,而非由液电碎石直接导致,再次行十二指肠乳头处和谐夹夹闭止血。经口胆胰管镜直视液电碎石组有3例胆管炎,考虑为无透明帽辅助下碎石时,视野不清晰,从而增加碎石操作时间,胆道内介质水灌注量增多,胆道压力过高所致;术后给予支架或鼻胆管引流,同时联合使用抗生素后症状缓解。两组均有部分患者术后出现不同程度的胰腺炎,透明帽辅助经口胆胰管镜直视液电碎石组有2例患者出现高淀粉酶血症,考虑由多种因素共同引起,包括液电碎石、反复进出十二指肠乳头导致乳头摩擦水肿、球囊扩张十二指肠乳头或十二指肠乳头括约肌切开等。所有患者均在禁食水、抗炎、抑制胰酶分泌及活性药物保守治疗后好转。经口胆管胰镜直视液电碎石组发生3例胆管壁损伤,均在液电光纤放电碎石过程中。由于未使用透明帽固定结石,加之碎石瞬间视野清晰度骤降,故光纤远端意外贴近并烫伤胆管壁,造成不同程度的损伤。上述患者术后均予留置双猪尾支架,术后无腹痛、发热等临床症状。
困难胆总管结石包括结石直径≥15 mm、数量多、坚硬、形状奇特(如铸型)等,传统的ERCP难以一次性完全清除此类结石。2019年欧洲胃肠内镜学会指南[8]建议,将内镜十二指肠乳头括约肌切开术联合内镜下十二指肠乳头大球囊扩张术作为困难胆总管结石取石的关键步骤,以降低出血、穿孔、胰腺炎等不良事件的发生风险。对于胆总管远端狭窄者,上述操作属于相对禁忌证。此外,可以通过机械碎石的方式将困难胆总管结石取出,但可能需要多次取石操作才能取净,同时术中易出现网篮断裂、牵引丝断裂或手柄断裂等情况,从而增加操作的风险及难度[9]。随着内镜设备的研发及更新,经口胆胰管镜直视下能量碎石(液电或激光)已广泛应用于困难胆总管结石的微创治疗[6,10-11]。多项研究表明,其治疗成功率高达67%~100%[12-15]。与传统ERCP相比,经口胆胰管镜直视下能量碎石导致的胆管炎及胆管损伤发生率更高。其中,胆管炎的发生主要与术中水冲洗所致胆道内压力升高密切相关,且碎石时间延长伴随冲洗时间增加,进而导致胆道内压力进一步升高,这可能是胆管炎风险递增的关键因素[9,16-17];胆管壁损伤则多因液电碎石过程中视野清晰度下降,操作者难以准确判断位置,盲目追加碎石,可能直接击打胆管壁使其损伤[6]。为降低胆管炎、胆管损伤等不良事件的发生率,保持碎石过程中视野清晰,缩短碎石时间至关重要[18]。
相关病例报道表明,佩戴透明帽辅助经口胆胰管镜合并激光碎石,可以用透明帽固定结石,使光纤始终在视野内靶向碎石,同时有助于保持视野清晰、缩短操作时间,对小乳头患者可以辅助插管[19-20]。目前,透明帽辅助经口胆胰管镜直视下液电碎石的临床获益尚缺乏大样本研究的证据支持。基于此,本研究通过回顾性分析,旨在评估透明帽辅助该术式的安全性与有效性。结果显示,与经口胆胰管镜直视液电碎石组相比,透明帽辅助经口胆胰管镜直视液电碎石组的一次性完整碎石取石技术成功率更高,手术操作时间、液电碎石时间更短,差异均有统计学意义(P值均<0.05);两组的临床成功率均为100%。经口胆胰管镜直视液电碎石组的技术成功率低于透明帽辅助组,分析其原因,无透明帽辅助时视野浑浊,难以准确捕捉结石位置,进而增加碎石难度和操作时间,对于高龄、基础疾病较多或结石多发的患者,首选支架引流后择期行二次取石。透明帽辅助可增加胆总管巨大结石的一次性治疗成功率并缩短操作时间,主要是因为透明帽辅助经口胆胰管镜进入胆道内,可以用锥形透明帽头端顶住并固定结石位置,碎石过程中透明帽可逐步追踪结石,使视野更加清晰。佩戴透明帽的碎石过程中若视野模糊,需反复用灭菌水灌洗,当视野再次清晰时才可以继续液电碎石,此过程会增加碎石及ERCP整体操作时间。
在不良事件发生方面,两组间差异均无统计学意义(P值均>0.05)。佩戴透明帽辅助经口胆胰管镜直视液电碎石并未增加并发症发生率,考虑透明帽辅助可能降低胆管壁损伤及胆管炎的风险,原因包括:(1)锥形透明帽的辅助,可使液电光纤位于视野正中,避免在无法直视光纤的情况下盲目插入导致光纤扎穿胆管壁;(2)液电光纤跟随透明帽远端调整插入深度,锥形透明帽先端可卡住胆总管巨大结石表面,固定结石便于反复碎石,从而缩短碎石时间;(3)透明帽辅助下,碎石过程需在水介质下进行,有助于保持视野清晰,从而缩短操作时间,同时可降低胆道内压力,减少胆管炎的发生率。然而,本研究纳入的样本量有限,未能观察到并发症发生率的组间差异,该结论有待大样本前瞻性研究予以进一步验证。
针对透明帽辅助经口胆胰管镜直视液电碎石的操作,总结以下注意事项:(1)佩戴透明帽时应确保牢固,防止操作中透明帽脱落甚至掉入胆道内;(2)透明帽辅助经口胆胰管镜直视液电碎石过程中,液电光纤必须伸出锥形透明帽远端,而非保留在透明帽内碎石,否则碎石后可能造成透明帽破裂,无法调整液电光纤于视野正中;(3)经口胆胰管镜退出十二指肠镜工作管道后,若发现透明帽脱落,应第一时间观察十二指肠镜工作管道入口处有无透明帽残留痕迹,若有则取出,避免透明帽随其他器械进入胆道内而影响操作。
综上所述,透明帽辅助经口胆胰管镜直视液电碎石治疗胆总管巨大结石效果良好,无严重并发症,安全有效,值得临床进一步推广。

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2026年第42卷第8期
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doi: 10.12449/JCH260823
  • 接收时间:2026-02-25
  • 首发时间:2026-10-16
  • 出版时间:2026-08-25
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  • 收稿日期:2026-02-25
  • 录用日期:2026-03-27
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    吉林市人民医院消化内科,吉林 吉林 132001

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王宏光, (ORCID:0000-0003-1100-9804)
Wang Hongguang, (ORCID:0000-0003-1100-9804)
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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