改良经皮肝胆道镜治疗复杂肝内外胆管结石

Modified procedures of Percutaneous transhepatic choledochoscopic lithotomy(PTCSL) in treatment of complicated hepatolithiasis and choledolithiasis

目的探讨改良经皮肝胆道镜(mPTCS)治疗复杂肝内外胆管结石的临床应用效果。方法回顾分析2008年2月至2010年12月我科采用改良经皮肝胆道镜治疗复杂肝内外胆管结石患者20例。男性12例,女性8例,年龄为45-87岁。18例患者术前有胆道或腹部手术病史。结石位于肝内胆管和或胆总管。结果平均每例PTCS操作为1-3次。总体胆管结石清除率为90%。手术后发生轻度并发症:窦道损伤1例和胆管炎1例,经保守治疗后均治愈。总住院时间为14天。结论 PTCS在治疗复杂肝内外胆管结石方面具有安全,有效,微创易重复操作优点。mPTCS较传统PTCS操作相比,结石清除率高,操作相关并发症及术后并发症少,而且明显缩短住院时间,值得在临床进行推广。

Objective To investigate the clinical effects of modified percutaneous transhepatic cholangioscopic lithotomy （mPTCSL） on complicated hepatolithiasis and/or choledocholithiasis. Methods From February 2008 to December 2010, 20 cases with complicated hepatolithiasis and choledocholithiasis received modified mPTCSL were analyzed retrospectively. The series included 12 men and 8 women, ranging in age from 45 to 87 years old. 18 of them had previous surgical interventions before operation. Results In modified procedures, complete stone clearance rate was 90 %. Postoperative complications： mild sinus tract injury and cholangitis were found in one case respectively and these cases were cured by conservative treatment. Total hospital stay was 14 days. Conclusion Modified PTCSL possesses many advantages, including safe, effective, minimally invasive and easy to repeat manipulation for treating complicated hepatolithiasis and choledocholithiasis. It has a high clearance rate of calculi, less intra-postoperative complications and shorter hospitalization time compared with traditional PTCSL.