经皮肝胆道硬镜碎石术治疗肝内胆管结石68例临床分析

Clinical effect of percutaneous transhepatic cholangioscopic lithotomy for intrahepatic bile duct stone in 68 cases

目的探讨经皮肝胆道硬镜碎石术治疗肝内胆管结石的有效性和安全性。方法回顾性分析我院2014年1月至2015年7月68例应用经皮肝胆道硬镜碎石术治疗肝内胆管结石患者的临床资料。结果 68例患者均成功施行经皮肝胆道硬镜碎石术,其中56例一次性取净结石,结石取净率为82.4%(56/68),12例经2次、3次手术取净结石。手术时间50~210 min,平均100.0±12.5 min;取石次数为1~3次,平均1.2±0.9次;术中出血量2~180 mL,平均20.0±5.5 mL;住院3~21 d,平均8.0±3.1 d。术后并发右侧胸腔积液1例,并发症发生率为1.5%,术后未发生胆漏、严重出血等并发症。随访2年,3例结石复发,复发率为4.4%。结论经皮肝胆道硬镜碎石术对于肝内胆管结石的治疗是微创、安全和有效的,但并发症、解释残余率高是其实施的主要限制。

Objective To report the experience in performing percutaneous transhepatic cholangioscopic lithotomy(PTCSL)for treating intrahepatic bile duct stone.Methods Retrospective analysis of therapeutic result of68patients with intrahepatic bile duct stone during January2014to June2016.Results All of68cases were successfully performed with percutaneous transhepatic cholangioscopic lithotomy.In each patient,the number of sessions of PTCS varied from1to3,and56cases(82.4%)got stone removal on one session12cases got stone removal in two?or three?stage.The blood loss was ranged from2to180mL.The hospitalization was3to21days.Right pleural effusion occurred in one cases after operation.Postoperative complication rate was1.5%.No serious complications such as bile leakage and bleeding occurred.After2years of follow?up,3stones recurred(4.4%).Conclusion In our series,PTCSL was a safe and effective method with minimal invasion for management of the intrahepatic bile duct stone,PTCS is a useful alternative management for the intrahepatic bile duct stone to surgery for biliary calculi,but it has limitations that obviate complete stone clearance.