经皮肝胆道镜碎石在治疗肝胆管结石中的应用

Application of percutaneous transhepatic cholangioscopy lithotripsy for the hepatolithiasis

目的研究经皮肝胆道镜碎石(PTCSL)治疗肝胆管结石的临床应用价值。方法 2007年3月～2012年7月43例肝胆管结石患者接受改良的PTCSL治疗:经皮肝胆道引流(PTBD)1周后经皮肝扩张胆道造瘘、瘘道内置保护性鞘管和应用硬质胆道镜辅助碎石取石,其中12例未行PTBD,即穿刺扩张作Ⅰ期造瘘取石。根据术中情况及术后恢复综合评价PTCSL疗效。结果 43例患者改良PTCSL明显优于传统经皮肝胆道镜(PTCS),平均手术时间(97.2±10.3)min,住院时间(16.7±4.3)d,术中出血量(20.4±3.7)mL,手术并发症发生率为6.9%(3/43),Ⅰ期完全取尽结石者12例,Ⅱ期取尽者19例,Ⅲ期5例,Ⅳ期3例,结石残留率为9.3%(4/43)。结论 PTCSL对治疗肝胆管结石,尤其对多次胆道术后复发或残留的复杂性肝胆管结石是一种安全、有效、易重复的方法,具有取石快、结石残留率低、术后并发症少、微创等优点。

[Objective] To study the application value of percutaneous transhepatic cholangioscopy lithotripsy （PTCSL） in the treatment of the hepatolithiasis. [Methods] 43 cases with hepatolithiasis admitted between January 2007 and September 2012 at our institution accepted modified PTCSL. The modified PTCSL that dilated fistula a week later after percutaneous transhepatic biliary drainage （PTBD） inserted a peel-way sheath and used a rigid cholangioscopy assisted to lithotripsy and lithotomy. 12 patients accepted one session of modified PTCSL without PTBD. Then the value of modified PTCSL technology was evaluated according to the surgery results and postoperative recovery. [Results] The modified PTCSL results of the 43 cases were better than traditional PTCS obviously. The mean time of surgery was （97.2±10.3） min, and hospital stay mean time was （16.7±4.3） d. The blood lost during operation was （20.4±3.7） mL. The rate of complication was 6.9% （3/43） and the rate of residue stones was 9.3%（4/43）. [Conclusions] It is a safe, effective, and repeatable approach for hepatolithiasis treatment, especially for the multiple biliary operation or recurrent hepatolithiasis. It has the advantages of low residue stones rate, minimally-invasive, and less complication.