经皮肝穿刺胆管造瘘电子胆道镜取石术的临床疗效

Clinical effects of percutaneous transhepatic biliary fistula and electronic choledochoscopic lithotomy

目的:研究经皮肝穿刺胆管造瘘电子胆道镜取石术与开腹手术治疗肝内胆管结石的临床疗效。方法:选取2014年6月至2016年1月收治的86例肝内胆管结石患者,采用随机数字法将其分为对照组与观察组,每组43例,对照组行传统开腹胆道镜取石术,观察组行经皮肝穿刺胆管造瘘电子胆道镜取石术,比较术后两组患者近期、远期疗效。结果:观察组切口长度、术中出血量、手术时间、术后住院时间、术后疼痛评分、切口感染率、远期复发率均低于对照组(P<0.01);结石清除率高于对照组(χ~2=9.31,P=0.00)。结论:经皮肝穿刺胆管造瘘电子胆道镜取石术治疗首次、复发及残留肝内胆管结石具有出血少、疼痛轻、并发症少等优点,可同时降低远期复发率,是安全、可靠、高效的治疗方案,值得临床推广。

Objective： To study the short and long term effects of percutaneous liver puncture biliary fistula ＋ electronic choledochoscopic lithotomy and open surgery in the treatment of intrahepatic bile duct stones. Methods： Eighty-six patients of hepatolithiasis from Jun. 2014 to Jan. 2016 were selected as research objects,and randomly divided into the control group and the observation group,each of which contained 43 cases. Patients in the control group were treated with traditional open choledochoscopic lithotomy. Patients in the observation group were treated with choledochoscopic lithotomy by percutaneous transhepatic biliary fistula. The short and long-term effects of the two groups were compared. Results： The average incision length,the amount of bleeding,the operation time,postoperative hospitalization time,postoperative visual analogue scale pain score,incision infection rate and long-term recurrence rate of the observation group were significantly fewer than those of the control group（ P 〈 0. 01）. The removal rate of calculus in the observation group was significantly higher than that in the control group（ χ2= 9. 31,P = 0. 00）. Conclusions： Percutaneous transhepatic biliary fistula and electronic choledochoscopic lithotomy has the advantage in the treatment of first-onset hepatolithiasis,recurrent hepatolithiasis or residual intrahepatic bile duct stones. It causes less bleeding,pain and complications,and can reduce the long-term recurrence rate. It is a safe,reliable and efficient treatment,which is worth clinic popularization.