经皮经肝胆道镜取石术在胆总管结石并急性胆管炎患者中的治疗价值研究

Study on the Therapeutic Value of Percutaneous Transhepatic Choledocholithotomy in Patients with Common Bile Duct Stones and Acute Cholangitis

目的探讨经皮经肝胆道镜取石术在胆总管结石合并急性胆管炎治疗中的价值。方法选取我院(2016年1月至2017年1月)收治的100例胆总管结石合并急性胆管炎患者,根据不同治疗分为两组,对照组(n=50)接受腹腔镜胆囊切除术、腹腔镜胆总管探查取石术、T管引流术治疗,观察组(n=50)接受腹腔镜胆囊切除术、经皮经肝胆道镜取石术治疗,两组患者围术期情况和结石清除率以及术后并发症对比,具体包括手术时间、腹腔引流管拔除时间、胆道引流管拔除时间、肛门排气时间、住院时间,术后胆漏、右侧胸腔积液、胆道出血、并发症发生率和结石清除率。结果观察组患者手术时间、腹腔引流管拔除时间、胆道引流管拔除时间、肛门排气时间、住院时间分别为(90.24±15.54)min、(2.24±0.47)d、(8.04±1.32)d、(21.55±2.14)h、(7.84±1.35)d,对照组分别为(184.25±15.47)min、(2.25±0.48)d、(31.24±1.47)d、(21.57±2.15)d、(7.90±1.27)d,两组患者手术时间、胆道引流管拔除时间对比差异明显(t=30.3159、23.0342,P<0.05);两组患者腹腔引流管拔除时间、肛门排气时间、住院时间对比无差异(t=0.1053、0.0466、0.2289,P>0.05)。随访12~36个月,两组患者均没有出现严重并发症和死亡病例,观察组有1例出血量大,且循环不稳定,造影发现由肝右动脉小分支对比剂外溢造成,经动脉栓塞止血后恢复,另1例在引流管引流后停止。观察组患者并发症发生率、结石清除率分别为6.00%(3/50)、100.00%(50/50),与对照组相同,两组患者结石清除率和术后并发症对比无差异(P>0.05)。结论经皮经肝胆道镜取石术在胆总管结石合并急性胆管炎治疗中的临床效果满意,具有较高价值,值得有条件的医院临床推广应用。

Objective To explore the value of percutaneous transhepatic choledocholithotomy in the treatment of common bile duct stones with acute cholangitis.Methods 100 patients with common bile duct stones and acute cholangitis treated in our hospital(January 2016-January 2017)were selected and divided into two groups according to different treatments.The control group(n=50)received laparoscopic cholecystectomy.Laparoscopic common bile duct exploration lithotripsy and T-tube drainage.The observation group(n=50)received laparoscopic cholecystectomy and percutaneous transhepatic choledocholithotomy.The perioperative status and stone removal rate of the two groups were treated.Comparison of postoperative complications,including operation time,abdominal drainage tube removal time,biliary drainage tube removal time,anal exhaust time,hospitalization time,postoperative bile leakage,right pleural effusion,biliary bleeding,and complication rate And stone clearance.Results The observation group’s operation time,abdominal drainage tube removal time,biliary drainage tube removal time,anal exhaust time,and hospitalization time were(90.24±15.54)min,(2.24±0.47)d,(8.04±1.32)d,(21.55±2.14)h,(7.84±1.35)d,the control group were(184.25±15.47)min,(2.25±0.48)d,(31.24±1.47)d,(21.57±2.15)d,(7.90±1.27)d There was a significant difference in surgical time and biliary drainage drainage time between the two groups(t=30.3159,23.0342,P<0.05);there was no difference in abdominal drainage drainage time,anal exhaust time,and hospitalization time between the two groups(t=0.1053,0.0466,0.2289,P>0.05).During the follow-up period of 12 to 36 months,there were no serious complications and deaths in the two groups of patients.One patient in the observation group had a large amount of bleeding and unstable circulation.The angiography found that the small branch of the right hepatic artery was caused by the overflow of the contrast agent,and the artery was embolized.Healed after recovery,and another case stopped after drainage tube drainage.The complication rate and stone removal rate in the observation group were 6.00(3/50)and 100.00%(50/50),which were the same as those in the control group.There was no difference in stone removal rate and postoperative complications between the two groups(P>0.05).Conclusion Percutaneous transhepatic choledocholithotomy is satisfactory in the treatment of common bile duct stones with acute cholangitis,and has high value.It is worthy of clinical promotion and application in conditional hospitals.