经皮肝Ⅰ期胆道造瘘取石治疗有胆道手术史患者的肝内胆管结石

Percutaneous transhepatic one-step biliary fistulation for patients with hepatolithiasis and hepatobiliary surgery history

目的观察经皮肝Ⅰ期胆道造瘘(PTOBF)取石手术与传统经皮肝胆道镜技术(PTCS)治疗有胆道手术史的肝内胆管结石的临床疗效,探讨PTOBF取石手术的临床应用价值。方法回顾性分析广州医科大学附属第一医院2009年11月至2017年10月收治的68例肝内胆管结石患者资料。其中观察组(PTOBF取石组)35例患者,对照组(传统PTCS组)33例患者。比较两组患者取石率、术后并发症发生率、住院时间、同一疗程取石次数、结石复发率、狭窄未解除率等。结果PTOBF组取石率较传统PTCS组明显提高(82.9%比54.6%,P<0.05);住院时间明显缩短[(12.3±5.3)d比(17.4±7.0)d,P<0.05];同一疗程取石次数减少(2.2±1.3比2.8±1.0,P<0.05);结石复发率显著降低(17.4%比39.4%,P<0.05)。两组术后并发症发生率差异无统计学意义(14.3%比30.3%,P>0.05)。结论经皮肝Ⅰ期胆道造瘘取石手术治疗复发性肝内胆管结石是安全可行的,相对于传统PTCS,具有取石次数少、取石效果好、住院时间短等优点。

Objective To observe the clinical effect of percutaneous transhepatic one-step biliary fistulation (PTOBF) and percutaneous transhepatic cholangioscopy (PTCS) in the treatment of hepatolithiasis with hepatobiliary surgery history, and to explore the clinical application value of PTOBF. Methods This is retrospective analysis of 68 patients with hepatolithiasis who were admitted to hepatobiliary surgery in the First Affiliated Hospital of Guangzhou Medical University from November 2009 to October 2017. Among these cases, 35 patients in the observation group (group PTOBF) were treated with PTOBF, and 33 patients in the control group (group PTCS) received PTCS treatment. The final clearance rate, the postoperative complications rate, the hospitalization time, the operation times within the course of treatment, the recurrence rate and the residual stenosis rate of the two groups were compared. Results Compared with group PTCS, the clearance rate was significantly higher in group PTOBF(82.9% vs 54.6%, P<0.05), while the postoperative complications rate between the two groups are similar(14.3% vs 30.3%, P>0.05);Besides, the hospitalization time(12.3±5.3 d vs 17.4±7.0 d, P<0.05), the operation times within the course of treatment(2.2±1.3 vs 2.8±1.0, P<0.05) and the recurrence rate(17.4% vs 39.4%, P<0.05) of group PTOBF were obviously lower. Conclusions PTOBF is a safe and feasible treatment for hepatolithiasis with hepatobiliary surgery history. Compared with PTCS, it has the advantages of short hospitalization time, fewer operations and better recovery.