经皮肝穿刺一步造瘘法在肝内胆管结石患者中的应用效果

The application effect of percutaneous liver puncture one-step fistula on patients with intrahepatic bile duct stones

目的:探讨经皮肝穿刺一步造瘘法(PTCSL)在肝内胆管结石患者中的应用效果。方法:将2017年1月至2019年1月广西梧州市人民医院收治的120例复杂肝内外胆管结石患者按随机数字表法分为观察组和对照组,每组60例,观察组采用经皮经肝穿刺改良肾镜一步造瘘法治疗,对照组采用传统开放手术治疗。比较两组术中各临床指标、术后情况、并发症、肝功能、S.T.O.N.E各分级的清除率及手术接受度。结果:观察组手术切口大小、术中出血量小于对照组,胆道出血发生率、疼痛视觉模拟评分(VAS)、感染发生率、各并发症总发生率均低于对照组,观察组结石清除率和对于手术的接受程度高于对照组,手术时间、术后胃肠功能恢复时间和住院时间短于对照组(均P<0.05)。结论:经皮肝穿刺一步造瘘法治疗肝内胆管结石可缩短手术切口和手术时间,减少出血量,提高各级结石清除率,降低并发症发生率,促进术后恢复,且患者对手术的接受度也较高,不会影响肝功能,具有临床可推广性。

Objective: To analyze the application effect of percutaneous one-step hepatocentesis(PTCSL) on patients with intrahepatic bile duct stones. Methods: A total of 120 patients with complex intrahepatic and extrahepatic bile duct stones admitted to Wuzhou People’s Hospital from January 2017 to January 2019 were selected,and randomly divided into an observation group and a control group, with 60 cases in each group. The patients in the observation group received percutaneous transhepatic puncture and improved nephrostomy with one-step nephrostomy, while those in the control group received traditional open surgery. The intraoperative clinical indicators, postoperative conditions, complications, liver function, S.T.O.N.E grade clearance rate, and surgical acceptability were compared between the two groups. Results: The incision size, operation time, intraoperative blood loss, incidence of biliary tract bleeding, visual analogue scale(VAS), incidence of infection, stone clearance rate,and the total incidence of complications in the observation group were lower than those in the control group, but the calculi clearance rate in the observation group was higher. Moreover, the postoperative gastrointestinal function recovery time and postoperative hospital days in the observation group were shorter compared with the control group. The acceptance degree of operation in the observation group was 98.33%, which was higher than that in the control group(86.67%)(all P<0.05). Conclusion: One-step percutaneous hepatocentesis in the treatment of intrahepatic bile duct stones can shorten the surgical incision and operation time, reduce the amount of blood loss, improve the clearance rate of all levels of stones, reduce the incidence of complications, and promote postoperative recovery. In addition, patients have a high degree of acceptance of the operation, which will not affect the liver function, and is clinically applicable.