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

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

doi:10.12449/JCH260823

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

DOI: 10.12449/JCH260823

吉林市人民医院消化内科，吉林吉林 132001

基金项目:

吉林省卫生健康科技能力提升项目 (2022LC143)

伦理学声明：本研究方案于2023年5月14日经吉林市人民医院伦理委员会审批，批号：伦审第LS-2023-0004，所纳入患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

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。

详细信息

通信作者:
王宏光， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

计量
- 文章访问数: 6
- HTML全文浏览量: 1
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2026-02-25
- 录用日期: 2026-03-27
- 出版日期: 2026-08-25

Clinical application of transparent cap-assisted peroral cholangiopancreatoscopy-guided electrohydraulic lithotripsy for large common bile duct stones

Department of Gastroenterology，Jilin People’s Hospital，Jilin，Jilin 132001，China

Research funding:

Jilin Provincial Health Science and Technology Capacity Improvement Project (2022LC143)

More Information

Corresponding author: Wang Hongguang， wanghongguang1817@163.com （ORCID： 0000-0003-1100-9804）

摘要

摘要: 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
Abstract: 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

HTML全文

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。

图 1 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

Figure 1. Intraoperative procedure of direct visualization electrohydraulic lithotripsy for giant common bile duct stones via peroral cholangiopancreatoscopy assisted by a conical transparent cap

下载: 全尺寸图片幻灯片

表 1 两组患者术前临床资料比较

Table 1. Comparison of preoperative clinical data between the two groups

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±14.20	76.20±12.63	t=-1.825	0.073
性别［例（%）］			χ²=1.071	0.301
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=0.617	0.432
WBC（×10⁹/L）	8.00（6.10～12.00）	8.65（5.62～11.30）	Z=0.255	0.798
CRP（mg/L）	80.48（38.45～132.25）	56.40（21.50～100.91）	Z=0.878	0.380
TBil（μmol/L）	47.60（25.55～103.72）	58.30（27.80～91.00）	Z=0.094	0.925
DBil（μmol/L）	34.70（16.60～73.83）	43.00（15.30～77.10）	Z=-0.028	0.977
结石直径（mm）	17.32±3.01	15.83±4.03	t=1.616	0.111
注：WBC，白细胞；CRP，C反应蛋白；TBil，总胆红素；DBil，直接胆红素。

下载: 导出CSV

表 2 两组手术相关指标比较

Table 2. Comparison of surgical-related indicators between the two groups

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=4.022	0.045
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=2.012	0.044
液电碎石时间（min）	13.50（9.25～17.75）	8.00（6.25～11.75）	Z=2.749	0.006
∆WBC（×10⁹/L）	-1.20（-2.83～1.95）	0.30（-2.35～1.60）	Z=-0.880	0.379
∆NEU（%）	0.03（-0.06～0.15）	0.05（0.00～0.12）	Z=-1.057	0.290
∆CRP（mg/L）	-27.79±65.89	-12.92±52.86	t=-0.805	0.425
∆TBil（μmol/L）	-40.60（-82.80～-13.45）	-43.10（-54.98～-17.50）	Z=-0.282	0.778
∆DBil（μmol/L）	-41.25±34.09	-34.16±23.68	t=-0.701	0.488
注：ERCP，内镜逆行胰胆管造影术；WBC，白细胞；CRP，C反应蛋白；TBil，总胆红素；DBil，直接胆红素；NEU，中性粒细胞百分比；∆，术后值－术前值。

下载: 导出CSV

表 3 两组并发症情况比较

Table 3. Comparison of complications between the two groups

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）

下载: 导出CSV

参考文献(20)

[1]	Yu Kun, Yang Jiahua, Si Xianke, et al. Clinical effect of laser lithotripsy under the direct view of biliary subendoscope in the treatment of elderly patients with giant common bile duct stones[J]. J Hepatopancreatobiliary Surg, 2025, 37( 6): 372- 375. DOI: 10.11952/j.issn.1007-1954.2025.06.003. 于昆, 杨佳华, 司仙科, 等. 胆道子镜直视下激光碎石治疗高龄巨大胆总管结石的效果分析[J]. 肝胆胰外科杂志, 2025, 37( 6): 372- 375. DOI: 10.11952/j.issn.1007-1954.2025.06.003.
[2]	Ren Xiaoying, Wu Yongbiao, Ding Xiangyuan, et al. Clinical effect of endoscopic sphincterotomy with balloon dilation versus sphincterotomy alone in treatment of large common bile duct stones: A Meta-analysis[J]. J Clin Hepatol, 2020, 36( 4): 850- 854. DOI: 10.3969/j.issn.1001-5256.2020.04.028. 任效瑛, 吴永彪, 丁相元, 等. 十二指肠乳头括约肌切开后球囊扩张术和乳头括约肌切开术治疗巨大胆总管结石效果比较的Meta分析[J]. 临床肝胆病杂志, 2020, 36( 4): 850- 854. DOI: 10.3969/j.issn.1001-5256.2020.04.028.
[3]	Xiang R Y, Chen C C, Wang J, et al. Correction: Nasobiliary tube-assisted cholangioscopy-guided electrohydraulic lithotripsy successfully used to treat a difficult common bile duct stone[J]. Endoscopy, 2026, 58(S 01): C4. DOI: 10.1055/a-2792-3478.
[4]	Li X, Liu W H. Small but mighty: Cylindrical transparent cap-assisted cholangioscopic electrohydraulic lithotripsy and stone extraction for the treatment of difficult common bile duct stones[J]. Endoscopy, 2025, 57(S 01): E1290- E1291. DOI: 10.1055/a-2729-2655.
[5]	Kosztowny K, Klimczak T, Kraj T, et al. Direct peroral cholangioscopy with laser lithotripsy in treating choledocholithiasis-single-institution experience[J]. Pol Przegl Chir, 2024, 96( 6): 6- 11. DOI: 10.5604/01.3001.0054.4731.
[6]	Tao Liying, Wang Hongguang, Guo Qingmei, et al. Efficacy of endoscopic retrograde cholangiopancreatography combined with electrohydraulic lithotripsy under the direct view of eyeMax biliary-pancreatic imaging system in treatment of difficult choledocholithiasis[J]. J Clin Hepatol, 2024, 40( 2): 351- 355. DOI: 10.12449/JCH240220. 陶丽莹, 王宏光, 郭庆梅, 等. 内镜逆行胰胆管造影联合eyeMax胆胰成像系统直视下液电碎石治疗困难胆管结石效果观察[J]. 临床肝胆病杂志, 2024, 40( 2): 351- 355. DOI: 10.12449/JCH240220.
[7]	Liu W H, Huang X Y, Hu X, et al. Initial experience of visualized biliary cannulation during ERCP[J]. Endoscopy, 2023, 55( 11): 1037- 1042. DOI: 10.1055/a-2113-8952.
[8]	Manes G, Paspatis G, Aabakken L, et al. Endoscopic management of common bile duct stones: European Society of Gastrointestinal Endoscopy(ESGE) guideline[J]. Endoscopy, 2019, 51( 5): 472- 491. DOI: 10.1055/a-0862-0346.
[9]	Oh C H, Dong S H. Recent advances in the management of difficult bile-duct stones: A focus on single-operator cholangioscopy-guided lithotripsy[J]. Korean J Intern Med, 2021, 36( 2): 235- 246. DOI: 10.3904/kjim.2020.425.
[10]	Li G D, Pang Q P, Zhai H L, et al. SpyGlass-guided laser lithotripsy versus laparoscopic common bile duct exploration for large common bile duct stones: A non-inferiority trial[J]. Surg Endosc, 2021, 35( 7): 3723- 3731. DOI: 10.1007/s00464-020-07862-4.
[11]	Chen Junhong, Wen Lijia, Liu Kai. Efficacy and safety of SpyGlass treating difficult bile duct stones: A Meta-analysis[J]. China J Endosc, 2021, 27( 11): 6- 16. DOI: 10.12235/E20210135. 陈俊宏, 闻丽加, 刘凯. SpyGlass治疗难治性胆管结石有效性和安全性的Meta分析[J]. 中国内镜杂志, 2021, 27( 11): 6- 16. DOI: 10.12235/E20210135.
[12]	Wong J C, Tang R S, Teoh A Y, et al. Efficacy and safety of novel digital single-operator peroral cholangioscopy-guided laser lithotripsy for complicated biliary stones[J]. Endosc Int Open, 2017, 5( 1): E54- E58. DOI: 10.1055/s-0042-118701.
[13]	Pallio S, Sinagra E, Santagati A, et al. Digital single-operator cholangioscopy in treating difficult biliary stones: Results from a multicenter experience[J]. Minerva Gastroenterol, 2023, 69( 2): 261- 267. DOI: 10.23736/S2724-5985.21.02892-8.
[14]	Fugazza A, Gabbiadini R, Tringali A, et al. Digital single-operator cholangioscopy in diagnostic and therapeutic bilio-pancreatic diseases: A prospective, multicenter study[J]. Dig Liver Dis, 2022, 54( 9): 1243- 1249. DOI: 10.1016/j.dld.2022.04.019.
[15]	Bokemeyer A, Gerges C, Lang D A, et al. Digital single-operator video cholangioscopy in treating refractory biliary stones: A multicenter observational study[J]. Surg Endosc, 2020, 34( 5): 1914- 1922. DOI: 10.1007/s00464-019-06962-0.
[16]	Patel S N, Rosenkranz L, Hooks B, et al. Holmium-yttrium aluminum garnet laser lithotripsy in the treatment of biliary calculi using single-operator cholangioscopy: A multicenter experience(with video)[J]. Gastrointest Endosc, 2014, 79( 2): 344- 348. DOI: 10.1016/j.gie.2013.07.054.
[17]	Sethi A, Chen Y K, Austin G L, et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: A single-center experience[J]. Gastrointest Endosc, 2011, 73( 2): 251- 256. DOI: 10.1016/j.gie.2010.08.058.
[18]	Wang Xingru, Li Xiaoju, Wan Dandan, et al. Focus and controversy on the diagnosis and therapy of hepatolithiasis[J]. Chin J Dig Surg, 2024, 23( 4): 579- 589. DOI: 10.3760/cma.j.cn115610-20240129-00048. 王星入, 李晓举, 万丹丹, 等. 肝胆管结石病诊疗的焦点与争议[J]. 中华消化外科杂志, 2024, 23( 4): 579- 589. DOI: 10.3760/cma.j.cn115610-20240129-00048.
[19]	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. DOI: 10.1055/a-2602-3230.
[20]	Hu S S, Liu X G, Yang Y C, et al. Double the efficacy, half the effort: Columnar transparent cap-assisted cholangioscopy for bile duct stone extraction[J]. Endoscopy, 2025, 57(S 01): E963- E965. DOI: 10.1055/a-2665-7090.