PTCS术在复杂肝内外胆管结石中的应用

Application of PTCS in complicated intrahepatic and extrahepatic bile duct stones

目的探讨经皮肝胆道镜(percutaneous transhepatic cholangioscopy,PTCS)手术对复杂肝内外胆管结石的临床治疗效果。方法纳入梅州市人民医院2012年1月-2015年6月确诊为复杂肝内外胆管结石的患者76例,其中采用二步造瘘PTCS治疗组38例,行一步造瘘PTCS组38例,收集并比较2组患者术前、术中及术后资料,并对纳入研究病例进行2年随访。结果二步造瘘PTCS治疗组的结石复发率、胆管炎复发率均低于一步造瘘PTCS组,差异具有统计学意义(P<0.05);且二步造瘘PTCS治疗组肝内胆结石取净率高于一步造瘘PTCS组(P<0.05)。结论二步造瘘PTCS方法可以降低结石残存率和结石复发率,是治疗复杂肝内外胆管结石的有效治疗方法。

Objective To evaluate the clinical effects of percutaneous transhepatic cholangioscopy （PTCS） in com- plicated intrahepatic and extrahepatic bile duct stones. Methods Seventy-six cases of complicated intrahepatic and ex- trahepatic bile duct stones who were diagnosed in Meizhou City People＇ s Hospital from Jan. 2012 to Jun. 2015 were collected, and were divided into two-step stoma PTCS group （n = 38） and one-step stoma PTCS group （n = 38）. Preop- erative, intraoperative and postoperative data were compared between two groups. The patients were followed up for 2 years. Results Stone recurrence rate and cholangitis fistula recurrence rate of the two-step stoma PTCS group were low- er than those of one-step stoma PTCS group, the difference was statistically significant （P 〈 0.05）. Stone net rate of the two-step stoma PTCS group was higher than that of one-step stoma PTCS group （P 〈 0.05）. Conclusion Two-step sto- ma PTCS method can reduce stone recurrence rate and stone residual rate. It is an effective method for the treatment of complicated intrahepatic and extrahepatic bile duct stones.