经皮经肝一次性窦道建立联合钬激光碎石在高龄胆管结石合并胆管狭窄患者中的应用

The clinical application of primary sinus tract sinus establishment combined with holmium laser lithotripsy in elderly patients with choledocholithiasis and stricture

目的探讨一次性经皮经肝建立肝内胆管窦道,胆道镜联合钬激光碎石在高龄肝胆管结石合并良性狭窄患者的临床应用疗效及安全性。方法收集四川省人民医院(东院)肝胆外科2018年1月至2019年1月诊断肝内胆管结石伴胆管狭窄的56例高龄患者的临床资料,所有患者行经皮肝穿胆道引流术(PTCD)穿刺引流,同时一次性逐级扩张穿刺窦道,在胆道镜下联合钬激光进行肝内胆管结石碎石、取石。分析术中操作及术后并发症发生情况。结果53例患者一次性建立窦道,取出结石并解除狭窄,2例穿刺出血,1例钬激光解除狭窄时出血并及时中转手术。患者接受激光治疗2~8次,平均4次,每次操作时间平均30(28~32)min,所有患者狭窄环解除,切开处胆管黏膜修复,复查彩色超声或胆道造影无异常后拔除T管,平均随访6个月。无结石残留,肝功能及胆红素均正常,手术治疗效果显著。结论经皮经肝一次性建立窦道,采用胆道镜联合钬激光对于肝胆管结石合并良性狭窄的无法耐受手术的高龄患者提供了新的治疗途径。

Objective To investigate the clinical efficacy and safety of one-time percutaneous transhepatic establishment of intrahepatic bile duct sinus,choledochoscope combined with holmium laser lithotripsy in elderly patients with hepatolithiasis combined with benign stricture.Methods The clinical data of 56 elderly patients diagnosed with intrahepatic bile duct stones combined with stricture in our hospital from January 2018 to January 2019 were collected.All patients underwent PTCD puncture and drainage,and simultaneously expanded the punctured sinus channels step by step,intrahepatic bile duct stones lithotripsy and lithotomy were performed under choledochoscope combined with holmium laser.The intraoperative operation and postoperative complications were analyzed.Results The sinus tract was established in 53 patients,the stones were removed,and the stenosis was relieved.Two cases of puncture bleeding and 1 case of bleeding when the stenosis was relieved by holmium laser and the surgery was timely transferred.The patients received 4(2-8)times of laser lithotripsy,and it took 30(28-32)min for each treatment.The T tubules were removed when colour Doppler ultrasound and choledochography were rechecked well.The patients were followed-up for an average of 6 months with the liver function and cholerythrin recovered.Conclusion The one-time establishment of sinus tract combined with choledochoscope holmium laser provides a new therapeutic approach for the elderly patients with hepatolithiasis and benign stricture who cannot tolerate surgery.