经皮肝胆道造瘘硬质胆道镜治疗肝内胆管结石

Percutaneous hepatocholangiostomy rigid choledochoscope treatment of intrahepatic biliary calculi

目的探讨经皮肝胆道造瘘硬质胆道镜治疗肝内胆管结石的可行性、疗效及优势。方法 2009年6月至2010年7月采用经皮肝胆道造瘘硬质胆道镜碎石取石的方法治疗肝内胆管结石22例,其中男10例,女12例,年龄30～82岁,平均(50.9±10.1)岁;左肝胆管结石4例,右肝胆管结石4例,左右肝胆管结石5例,左右肝胆管合并胆总管结石9例。结果 22例均成功施行经皮肝胆道造瘘硬质胆道镜取石术,其中15例取净结石,7例仍有少许残余结石,结石取净率68.2%。手术时间40～270min,平均(113.0±41.9)min;取石次数为1～5次,平均(2.6±0.9)次;术中出血量5～200ml,平均(18.8±20.5)ml;住院天数4～53d,平均(19.4±2.3)d。术后并发右侧胸腔积液和右下肺不张1例,经非手术方法治愈。无胆瘘、胆汁性腹膜炎发生。结论经皮肝胆道造瘘治疗肝内胆管结石,尤其对多次胆道术后复发或残留的复杂性肝内胆管结石是一种安全、有效、创伤小、易重复的方法。经皮经肝穿刺胆管引流术3d后一次性扩张造瘘并取石是安全的。硬质胆道镜经皮肝瘘道行手术是可行的。

Objective To explore the feasibility,efficacy and advantages of the percutaneous hepatocholangiostomy （PCH） for intrahepatic biliary calculi with rigid choledochoscope. Methods The clinical data of 22 patients,included 10 cases of male, 12 cases of female,with mean age of （ 50.9 ± 10.1 ） years old （ range 30-82 years old ）,preoperative diagnosis indicated 4 cases of left intrahepatic biliary calculi, 4 cases of right,5 cases of bilateral,9 cases of ex-intrahepatic biliary calculi, who suffered from intrahepatic biliary calculi and underwent PCH and percutaneous transhepatic cholangioscopy treatment using rigid choledochoscope from June 2009 to July 2010. Results Twenty two cases were successfully treated. The stones were removed completely in 68.2 % （15/22）. The operation time was 40 to 270 min, with the average of （ 113.0 ±41.9 ） min. Operation number each ease were 1-5 times, with the average of （ 2.6 ± 0.9 ） times. The blood loss was （ 18.8 ± 20.5 ）ml （ ranging from 5 to 200 ml ）. Hospital stay was 4-53 d, with the average of （ 19.4 ± 2.3 ） d. The postoperative complications in only one case of right pleural effusion and right lower pulmonary atelectasis and was cured with non-surgical treatment.No biliaryfistula and bile peritonitis were found in postoperation. Conclusions PCH is a relatively safe and effective procedure for treating intrahepatie biliary calculi, especially for multiple biliary stones postoperatively and with complex intrahepatic biliary calculi,it is a minimal invasion and easy to repeat. To expand the sinus and perform PCH is safe after the pereutaneous transhepatic cholangial drainage （PTCD） 3 days. PTCD using rigid choledochoscope is feasiblity.