经皮经肝胆道镜碎石取石术治疗复发性Ⅱa型肝胆管结石病

Value of percutaneous transhepatic choledochoscopic lithotripsy in treatm ent of recurrent type Ⅱ a hepatolithiasis

目的探讨经皮经肝胆道镜碎石取石术(PTCSL)治疗复发性Ⅱa型肝胆管结石病的可行性及安全性。方法回顾性收集重庆医科大学附属第二医院2010年12月至2017年12月期间收治的复发性Ⅱa型肝胆管结石患者293例,其中82例行PTCSL(PTCSL组),采用传统开腹手术211例(开腹组),利用倾向性评分匹配的方法按配比度为1∶1匹配,对匹配后患者进行对比研究。结果共匹配成功59对,即PTCSL组59例和开腹组59例,2组患者性别、年龄、术前肝功能Child-Pugh分级、既往胆道手术次数等基线资料具有可比性(P>0.050)。2组均无围术期死亡患者。PTCSL组和开腹组患者在手术成功率、总手术时间、手术次数、术后T管拔除时间、结石残余率及结石复发率方面比较差异均无统计学意义(P>0.050)。虽然PTCSL组较开腹组住院费用高,但是PTCSL组在术中出血量、切口长度、术后通气时间、住院时间及术后总体并发症发生率方面有明显优势(P<0.050)。结论在跨越了学习曲线后,PTCSL比传统开腹术治疗复发性Ⅱa型肝胆管结石病有诸多优势,更安全、有效和微创。

Objective To investigate the feasibility and safety of percutaneous transhepatic choledochoscopic lithotripsy(PTCSL)in the treatment of recurrent typeⅡa hepatolithiasis.Methods All of 293 patients with recurrent typeⅡa hepatolithiasis admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2010 to D ecember 2017 were collected retrospectively,82 of whom were treated with the PTCSL(PTCSL group),211 of whom were treated with trad itional open surgery(open group).The patients were matched according to the ratio of 1:1 by using the method of propensity score matching,then the patients were com pared after matching.Results A total of 59 pairs were successfully m atched,that was,there were 59 patients in the PTCSL group and open group,respectively.C om pared with the open group,the PTCSL group had the similar conditions such as the gender,age,preoperative Child-Pugh classification,and times of previous biliary operations,etc.(P>0.050).There was no perioperative death in both groups.There were no significant differences between the two groups in the success rate,operation time,tim es of operations,time of T tube removal after operation,stone residual rate,and stone recurrence rate(P>0.050).Although the hospital costs of the PTCSL group was higher than that of the open group(P<0.050),the PTCSL group had various advantages,such as less intraoperative bleeding,smaller incisional scar,shorter hospital stay and postoperative ventilation time,and lower rate of total postoperative complications(P<0.050).Conclusions After learning curve,PTCSL has many advantages over traditional open surgery in treatment of recurrent type Ⅱ a hepatolithiasis.PTCSL is a minimally invasive surgery,which is safe and effective.