经皮肝胆道镜与腹腔镜在胆石症术后复发治疗中的应用分析

Effect of PTCS and Laparoscopy on Postoperative Recurrence of Intra-and extrahepatic Bile duct Stone

目的探讨胆石症术后复发采用经皮肝胆道镜(Percutaneous Transhepatic Cholangioscopy,PTCS)与腹腔镜治疗的临床价值。方法对2014年1月—2017年9月肝胆外科收治的33例胆石症术后复发的患者,采用回顾性队列研究方法,其中22例为开腹手术后,11例为腹腔镜术后,按手术方式的不同分为观察组15例和对照组18例,观察组行PTCS手术,对照组行腹腔镜手术。观察两组手术情况:术中出血量、手术时间、术后排气时间、术后胆漏与出血的发生情况、住院时间、住院费用、结石残留等。结果观察组手术时间较对照组有统计学差异(P<0.05),术中出血量观察组较对照组明显减少,有统计学差异(P<O.05)。观察组术后排气时间明显短于对照组,术后并发症的发生率尤其是胆漏率明显低于对照组,需要口服止痛药物的患者比例低于对照组,总住院时间明显短于对照组,均具有统计学差异(均P<O.05)。结石残留例数比较无统计学差异(P>0.05)。结论 PTCS技术治疗胆石症复发较腹腔镜手术具有微创的优势,值得进一步研究及推广。

Objective To explore the clinical value of percutaneous transhepatic cholangioscopy( PTCS) and laparoscopy in the treatment of recurrent intra-and extrahepatic bile duct stone. Methods A retrospective cohort study was made on 33 patients with recurrence of postoperative choledochofiberscopy during January 2014 and Septmber 2017 in the hepatobiliary surgery. Among these patients,22 received laparotomy operation while 11 underwent laparoscopic surgery before the recurrence. According to different surgeries,they were divided into two groups: 15 in the observation group with PTCS,and 18 in the control group with laparoscopic surgery. The surgical situations of two groups were observed including blood loss and time of the surgery,postoperative exhaust time,bile leakage and bleeding,hospital stays and fees,residual stones,etc.Results Comparing with the control group,the operation time of the observation group had significant difference,and blood loss also decreased dramatically in the observation group( P < 0. 05). Postoperative exhaust time and incidence of complications such as bile leakage were much lower than that in control group; the number of patients administering oral analgesics and total hospital stays were significantly less than that in control group( P < 0. 05). The postoperative residual rate of bile stones of the two groups has no significant difference( P > 0. 05). Conclusion In comparison with laparoscopy,PTCS has an advantage of minimal invasion,which is worth further study and spread Ing.