经皮穿肝十二指肠乳头肌扩张术治疗胆总管结石

Clinical study of percutaneous transhepatic balloon dilation：a novel procedure for common bile duct stone

目的 评估经皮穿肝十二指肠乳头肌球囊扩张术治疗胆总管结石的安全性和有效性.方法 回顾性分析山东大学第二医院介入医学科2008年7月至2011年4月共68例其他治疗失败、不能或拒绝内镜或手术治疗的胆总管结石病例,选择经皮穿肝十二指肠乳头肌球囊扩张术进行治疗.检测术前、术后1周及1个月CA19-9、总胆红素等指标,观察术后1周内出血、穿孔、胰腺炎、胆管炎等近期并发症,随访2年,观察结石复发及返流性胆管炎等远期并发症.分析讨论各项指标术前术后变化及各指标间相关性.结果 68例胆总管结石病例均顺利完成手术治疗.53例接受了1次经皮穿肝球囊扩张术,15例接受了两次或以上的经皮穿肝球囊扩张术.术前CA19-9 （135±212） U/ml（正常〈37 U/ml）,最高〉2500 U/ml,术后1周及1个月分别降至（64±133）、（23±54） U/ml（P〈0.01）.术前总胆红素（159±76） mmol/L,术后1周及术后1个月分别降至（66±42）、（14±8） mmol/L（P〈0.01）.术前直接胆红素（104±52） mmol/L,术后1周及术后1个月分别降至（39±22） mmol/L、（11±9） mmol/L（P〈0.01）.CA19-9与总胆红素、直接胆红素明显相关.平均手术时间（64±19） min;围手术期胆系感染4.4%（3/68）,胆道出血2.9%（2/68）,胰腺炎1.5%（1/68）,无胃肠道、胆道穿孔等严重并发症.术后2年结石复发14.7%（10/68）,反流性胆管炎5.9%（4/68）.结论 经皮穿肝十二指肠乳头肌扩张术是一种安全、有效的治疗胆总管结石手段.

Objective To investigate the safety and efficacy of percutaneous transhepatic balloon dilation for the removal of common bile duct stone. Methods Sixty-eight cases with common bile duct stone treated with percutaneous transhepatic balloon dilation in our department from July 2008 to April 2011 were analyzed retrospectively. Record CA19-9, total bilirubin, indirect bilirubin and albumin before the procedure, 1 week and 1 month later. Check if immediate complications occurs, including hemorrhage, perforation, pancreatitis and cholangitis. During the following up for 2 years, stone recurrence, reflux cholangitis and other long-term complications were observed. Analyze the changes of indicators between preoperative and postoperative and the correlation. Results All of the 68 patients were treated successfully. 53 patients underwent one procedure, and 15 patients received twice or more times of procedures. CA19-9, TBIL and IBIL decreased significantly 1 week later and 1 month later compared with those before the procedure, while ALB was opposite. Incidences of biliary tract infection, hemorrhage, and pancreatitis were 4. 4% （3/68）, 2. 9% （2/68） and 1.5% （1/68） respectively. No severe complications occurred, including perforation of gastrointestinal or biliary tract. Incidences of recurrent stone and refluxcholangeitis were 14.7% （10/68） and 5.9% （4/68） in two years after the procedure. Conclusion Percutaneous transhepatic balloon dilation is a safe and effective procedure for patients with common bile duct stone. For the cases which could not be handled with endoscopic procedures, it provides a new therapeutic approach.