经皮经肝胆道镜术在复杂肝内外胆管结石中的应用

Application of percutaneous transhepatic cholangioscopy in complicated calculus of intra-and-extra-hepatic bile duct

目的观察经皮经肝胆道镜(PTCS)治疗复杂肝内外胆管结石的临床效果。方法选择130例肝内外胆管结石确诊患者,采用随机数字表法分为PTCS组和对照组,每组65例。PTCS组行PTCS术,对照组行常规开腹胆总管探查取石术。比较两组在结石取净率、出血量、术后并发症、住院时间、住院费用及随访复发等指标的差异。结果 PTCS组结石取净率(90.77%)与对照组(89.23%)比较差异无统计学意义(P>0.05)。PTCS组的术中出血量(38.46±7.54)m L低于对照组(125.68±12.37)m L(P<0.05)。PTCS组并发症发生率(6.16%)与对照组(10.77%)比较差异无统计学意义(P>0.05)。PTCS组的平均住院时间(11.8±3.56)d低于对照组(18.68±5.23)d,差异有统计学意义(P<0.05),PTCS组的平均住院费用(1.26±0.66)万元低于对照组(1.95±0.96)万元,差异有统计学意义(P<0.05)。出院1年后PTCS组结石复发率为19.05%,低于对照组的39.06%,差异有统计学意义(P<0.05)。结论 PTCS术手术成功率高,并发症和复发率低,值得临床推广。

Objective To investigate the clinical efficacy of percutaneous transhepatic cholangioscopy（PTCS）in complicated calculus of intra-and-extra-hepatic bile duct.MethodsA total of 130 patients with calculus of intra-and-extra-hepatic bile duct were chosen and assigned into 2 groups by table of random numbers.Sixty-five patients in observation group adopted PTCS and 65 patients in control group took open common bile duct exploration surgery.Removing of calculus,blood loss,postoperative complications,hospital stay,hospitalization expense and calculus recurrence rate were compared.ResultsRemoving rate of calculus in PTCS group was 90.77%,higher than that of control group which was 89.23%（P〈0.05）.The amount of blood loss in PTCS group was（38.46±7.54）mL,lower than that of controls（125.68±12.37）mL（P〈0.05）.Rate of complication in PTCS group（6.16%）was lower than that of controls（10.77%）（P〈0.05）.Hospital stay（11.8±3.56）d and expense（1.26±0.66）ten thousand Yuan in PTCS group were inferior to those of controls（18.68±5.23 d and 1.95±0.96 ten thousand Yuan,respectively）（P〈0.05）.The rate of calculus recurrence in PTCS group was 19.05%,lower than that of controls（39.06%）（P〈0.05）.ConclusionsPTCS has satisfactory success rate,low complications and recurrence rate,which deserves clinical promotion.