经皮经肝胆道镜及肾镜联合超声碎石经胆道造瘘窦道治疗胆管结石

Percutaneous transhepatic choledochoscope and nephroscope in combination with ultrasonic lithotripsy for the treatment of hepatic bile duct calculus

目的 探讨与评价经皮经肝胆道镜（percutaneous transhepatic choledochoscope,PTCS）、经皮肾镜（percutaneous nephroscope,PCN）联合超声碎石清石系统经胆道造瘘窦道治疗高龄患者肝内外胆管结石的安全性与疗效.方法 回顾性分析70岁以上高龄肝内外胆管结石患者23例,其中胆囊切除术后胆总管结石复发18例、胆总管结石合并肝内胆管结石5例,均经皮经肝穿刺造瘘窦道取石.结果 手术均成功,单次治疗结石取尽率为87％,3例残留结石,二次手术完全取尽.平均手术时间（118 ±43） min,术中平均失血（16±17.3） ml,无重症胆管炎等严重并发症,随访3～26个月,未见结石残留、复发、胆管狭窄及其他严重并发症.结论 对于胆石症术后残留胆管结石患者,胆道镜、经皮肾镜联合超声碎石清石系统经造瘘窦道治疗肝内外胆管结石效率高、严重并发症少,是一种安全有效的治疗方法.

Objective To investigate the therapeutic effect and complications of PTCS and PCN combined with ultrasonic lithotripsy in the treatment of intra-and extrahepatic bile duct stones in elderly age 〉 70 and poor risk patients.Methods Twenty three elderly patients with choledocholithiasis were enrolled,including post-cholecystectomy 18 cases with choledocholithiasis,intra-and extrahepatic bile duct calculus in 5 cases.After establishment of percutaneous transhepatic fistula,stones were removed in operating theatre under anesthesia.Results All operations were successful.The clearance rate of calculus after first round of therapy was up to 87%.The mean operation time was （118 ± 43） min,blood loss was （16 ± 17.3） ml,there was not serious complications such as massive bleeding and severe cholangitis.After 3-26 months following up,there was no postoperative serious complications as residual and recurrence of calculus and no biliary stricture.Conclusions For postoperative remaining bile duct stones in elderly patients,PTCS and PCN combined with ultrasonic lithotripsy is effective and safe for stones clearance.