一期或二期经皮经肝胆道镜碎石取石术治疗肝内胆管结石的疗效比较

Comparison of the efficacy and safety of primary or secondary PTCS for patients with intrahepatic bile duct stones

目的探讨一期或二期经皮经肝胆道镜碎石取石术(PTCS)对肝内胆管结石疗效及安全性的影响。方法选取凉山州中西医结合医院2015年1月至2018年8月收治肝内胆管结石病人114例,其中行二期PTCS术74例设为A组,行一期PTCS术40例设为B组,比较两组结石清除率、手术时间、术中出血量、术后住院时间及术后并发症发生情况。结果A组和B组结石清除率比较,差异无统计学意义(85.14%比87.50%,χ^2=0.120,P=0.729)。A组和B组手术时间[(65.56±14.40)min比(63.40±13.72)min]和术中失血量[(24.73±5.10)mL比(26.07±5.87)mL]比较,差异无统计学意义(P>0.05);B组住院时间(5.22±1.74)d显著少于A组(8.97±2.30)d(P<0.05);B组胆道出血发生率17.50%高于A组4.05%(P<0.05)。结论一期和二期PTCS术用于肝内胆管结石治疗总体结石清除效果接近,其中一期手术可有效缩短术后住院时间,且安全性良好,更具临床应用价值。

Objective To investigate the influence of primary or secondary PTCS on clinical efficacy and safety of patients with intrahepatic bile duct stones.Methods A total of 114 patients with intrahepatic bile duct stones were admitted to Liangshan Prefecture Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to August 2018,and were divided into both groups including A group(74 patients)with secondary PTCS and B group(40 patients)with primary PTCS;and the stone clearance rate,operation time,intraoperative bleeding volume,hospital staying time and complications occurrence after operation of both groups were compared.Results There was no significant difference in the stone clearance rate between 2 groups(85.14%vs.87.50%,χ^2=0.120,P=0.729).There was no significant difference in the operation time[(65.56±14.40)min vs.(63.40±13.72)min],intraoperative bleeding volume[(24.73±5.10)mL vs.(26.07±5.87)mL]between 2 groups(P>0.05).The hospital staying time of B group(5.22±1.74)d were significantly shorter than A group(8.97±2.30)d(P<0.05).The incidence of biliary tract hemorrhage of B group 17.50%were significantly higher than A group 4.05%(P<0.05).Conclusion Primary and secondary PTCS in the treatment of patients with intrahepatic bile duct stones possess have the same clinical effects;but primary PTCS application can efficiently shorten the hospital staying time after operation and have the fine safety and more clinical application value.