经皮经胆囊十二指肠乳头肌球囊扩张排石术治疗胆总管结石的初步临床应用

Preliminary clinical efficacy of percutaneous transcystic papilla balloon dilation for removing common bile duct stones

目的 评估经皮经胆囊途径十二指肠乳头肌扩张术治疗胆总管结石的可行性、安全性和有效性.方法 回顾性分析2013年4月至2015年5月山东大学第二医院等中心收治的11例经皮经肝穿刺胆囊建立手术路径行十二指肠乳头肌球囊扩张排石术的病例.11例患者中,男3例、女8例,平均年龄68（52~91）岁,所有患者均无明显肝内胆管扩张,其中6例患者不能耐受内镜治疗或外科手术,4例患者拒绝内镜或外科治疗,1例患者内镜治疗失败.检测患者术前、术后1周、术后1个月白细胞数、CA19-9、总胆红素、直接胆红素、丙氨酸转氨酶、天冬氨酸转氨酶及血清淀粉酶,观察近期并发症.结果 11例患者均顺利完成手术治疗.术前白细胞为（8.2±2.1）×10^9/L,术后1周及1个月分别降至（7.4±1.9）×10^9/L、（7.2 ±1.6）×10^9/L.术前CA19-9为（150±35） kU/L,术后1周及1个月分别降至（118±27） kU/L、（43±12） kU/L.术前直接胆红素为（100±32） mmol/L,术后1周及1个月分别降至（49±12） mmol/L、（9±3） mmol/L.围手术期胆管感染1例,无胆管穿孔、胃肠道穿孔、胰腺炎等术后相关并发症的发生.术后2年胆总管结石复发1例.结论 经皮经胆囊十二指肠乳头肌扩张排石术治疗胆总管结石技术可行、安全,对于内镜治疗、外科手术失败以及无法经皮经肝穿刺的患者,有望成为一种有效的替代治疗方案.

Objective To evaluate the feasibility, safety, and preliminary efficacy of percutaneous transcystic papilla balloon dilation for the common bile duct stones.Methods A total of 11 patients with the common bile duct stones without dilatation of the intrahepatic bile ducts treated with percutaneous transcystic papilla balloon dilation in multiple center from April 2013 to May 2015 were analyzed retrospectively.In these 11 patients, there were 3 males and 8 females.And the average age was 68（52-91） years old.All patients had no obviously dilated intrahepatic bile duct, 6 patients were not suitable for endoscopic treatment or surgery, 4 patients refused endoscopic or surgical treatment and 1 patient had a history of failed endoscopic treatment.The white blood cell count, CA19-9, total bilirubin, direct bilirubin,AST,ALT and serum amylase level were recorded before the procedure, 1 week, and 1 month later.Early complications, such as cholangitis, pancreatitis, hemorrhage,and perforation were evaluated.Results Technical success was achieved in all the 11 cases.The level of CA19-9, total bilirubin and direct bilirubin decreased significantly 1 week and 1 month after the procedure.One patient suffered from biliary tract infection.No severe complications, such as perforation of biliary or gastrointestinal tract, occurred during the follow up.Common bile duct stone recurred in 1 patient 2 years after the procedure.Conclusions For cases who are not suitable for endoscopic treatment, surgery, or percutaneous transhepatic approach to treat the common bile duct stones, percutaneous transcystic papilla dilation is technically feasible and safe, and seems to be an appropriate alternative strategy.