| Objective: In recent years,with the development of endoscopic technology,the detection rate of bezoars has been continuously improved,and its treatment methods have also increased.Endoscopic mechanical lithotripsy is considered to be the preferred minimally invasive treatment method,but the current clinical endoscopic lithotripsy methods are different,and lack of effect evaluation.In our study,we used a new endoscopic mechanical lithotripter-transparent cap combined with zebra guidewire lithotripsy,and compared its clinical benefits with those of traditional lithotripsy with the aim of providing a practical basis for the development of endoscopic strategies for treating phytobezoars.Methods: In this study,46 patients diagnosed with bezoars and treated by endoscopic mechanical lithotripsy were selected as the research subjects.The general clinical data,preoperative related data,surgical and postoperative follow-up data of the patients were collected.The etiology,risk factors,epidemiological characteristics and clinical characteristics of phytobezoars were analyzed,and according to the inclusion and exclusion criteria,the patients were divided into two groups according to the treatment method to compare the use of transparent cap combined with zebra guidewire lithotripsy and traditional endoscopic mechanical lithotripsy（including snare lithotripter and biliary tract bezoar basket）in terms of lithotripsy length,lithotripsy times,complications,calculi residue,hospitalization fees,surgical consumables,and hospitalization duration.Results:（1）Baseline data: The baseline data of patients in the traditional lithotripsy group and the transparent cap combined with zebra wire lithotripsy group were compared,including age（p=0.53）,gender（p=0.38）,and number（p=0.54）of and diameters（p=0.10）of bezoars,and the presence of ulcers（p=0.07）and obstruction（p=0.15）.There were no significant differences in the baseline data between the two groups（p>0.05）;（2）General characteristics: the onset time of phytobezoars is more concentrated in winter and spring,there were 23（50%）and 12 cases（26.1%）,respectively,and the incidence was less in summer and autumn,with 5（10.9%）and 6cases（13%）.The most common reason is eating more high-fiber foods,of which persimmons or persimmon products were more common,accounting for 76.1%.The clinical manifestations of phytobezoars are often atypical,29 patients（63%）had abdominal distension as the main symptom,10 patients（21%）had abdominal pain as the main symptom,and the rest showed black stool in five patients（11%）and vomiting in two patients（5%）;（3）Compared with traditional endoscopic mechanical lithotripsy,the transparent cap combined with zebra wire lithotripsy procedure had a shorter duration（39.61±16.94 minutes and 127.57±36.66 minutes for the traditional versus the transparent cap combined with zebra wire lithotripsy group,respectively）,fewer lithotripsy times（1.22±0.43times: 1.6±0.87times）,shorter hospitalization（5.89±1.61 days and 7.14±3.47 days,respectively）,lower hospitalization fees（6556.76±2064.27￥ and 16346.63±6851.24￥,respectively）,and the costs of surgical consumables（2178.00±1066.95￥ and 7864.51±4369.94￥,respectively）;these differences were statistically significant（p<0.05）;（4）Postoperative indices: In the complications,1case in the guide wire lithotripsy group was complicated with mucosal injury,and the overall complication rate was 5.6%.In the traditional lithotripsy group,7 patients had mucosal injury,and 1 patient was complicated with small bowel obstruction,the complication rate was 28.6%.In terms of postoperative stone residues,the guide wire lithotripsy group was 5.6%,and the traditional lithotripsy group was25%,and the difference was not statistically significant（p>0.05）.（5）Effective rate: The effective rate of lithotripsy in the transparent cap combined with zebra guidewire lithotripsy group was 94.4%,and the effective rate in the traditional lithotripsy group was 71.4%,with no significant difference（p>0.05）.Conclusion: The adjustable zebra guidewire lithotripsy was superior to traditional endoscopic mechanical lithotripsy for treating phytobezoars,it is a more efficient,economical and safe method for endoscopic treatment of phytobezoars and is worthy of promotion. |
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