经皮经肝胆道置管扩张胆总管末端清除胆管结石40例分析

Transpapillary elimination of bile duct stones by balloon sphincteroplasty via percutaneous transhepatic cannulation: Report of 40 cases

目的探讨经皮经肝胆道穿刺造影置管,应用球囊扩张肝胰壶腹并推出胆道结石进入小肠的临床效果。方法 2007年1月至2015年3月40例胆管结石患者,21例肝(胆)总管结石患者加入A组,19例左(右)肝管结石患者加入B组。采用SPSS19.0统计软件,比较两组患者术前胆红素数值、手术操作时间、胆道结石大小等计量资料采用t检验;术中结石彻底清除率、术后结石复发率、并发症发生率等采用χ2检验,P<0.05为差异有统计学意义。结果术前A组血清直接胆红素(53.4±11.6)μmol/L高于B组(11.2±7.9)μmol/L,差异有统计学意义(t=13.3,P<0.001);A组的手术时间(61.2±15.3)min较B组(91.3±21.4)min明显缩短;胆道结石彻底清除成功率A组18例(85.7%)和B组10例(52.6%),χ2=5.62,P<0.025;彻底清除结石患者随访期间结石复发率及胆道狭窄率均分别是0和30%(P=0.036);以上两组差异均有统计学意义。结论经皮经肝球囊扩张肝胰壶腹清除胆管结石是安全有效的手术,它对于胆(肝)总管结石疗效优与肝管结石。

Objective To investigate the clinical application of an occlusion balloon for clearance of bile duct calculi into the small bowel via percutaneous transhepatic cholangiography and cannulation （PTCC）. Methods From January 2007 to March 2015, 40 patients with bile duct stones had been treated surgically. These patients were divided into two groups： 21 patients with common bile duct（CBD） stones （group A）, and 19 patients with right or left hepatic duct stones （group B）. Statistical analysis was performed using the SPSS19.0 software. Measurement data examined by Student＇s t test included preoperative serum bilirubin level and operation time and the size of stones. The successful rate of the procedure, recurrence and postoperative complications were examined by the Chi - square test. P 〈 0.05 was considered statistically significant. Results The preoperative serum bilirubin level was significantly higher in group A than in group B [ （53.4 ±11.6） μmol/L vs （ 11.2 ± 7.9） μmol/L respectively, （t = 13.3, P 〈 0. 001 ） ]. The operation time in group A was（61.2 ±15.3 ） min, which was significantly shorter than （91.3 ±21.4） min in group B. Complete bile duct clearance was achieved in 85.7% （ 18/21 ） of the patients in group A and 52.6% （10/19） in group B （χ^2 =5.62, P 〈0. 025）. There were no stone recurrence and bile duct stricture after complete clearance of the bile duct in groups A and B. Conclusion Balloon dilation of the papilla for clearance of bile duct calculi via PTCC is safe and effective, especially for patients with common bile duct stones.