胆道镜下球囊扩张取石术治疗肝内胆管结石合并胆管良性狭窄的疗效分析

Treatment strategy of hepatolithiasis with benign bile duct stricture

目的:探讨胆道镜下球囊扩张取石术治疗肝内胆管结石合并胆管良性狭窄的疗效。方法:回顾性分析山东省立第三医院近6年来134例接受胆道镜下球囊扩张取石术治疗的肝内胆管结石合并胆管良性狭窄患者病例资料。其中左外叶胆管狭窄30例,占22.39%;左内叶胆管狭窄25例,占18.66%;右前叶胆管狭窄26例,占19.40%;右后叶胆管狭窄47例,占35.07%;尾状叶胆管狭窄6例,占4.48%。76例为胆管"膜状狭窄";41例为"管状狭窄";17例为"门缝样狭窄"。以结石取净率、术中并发症、结石复发率作为疗效评价指标。结果:76例胆管"膜状狭窄"患者结石取净75例,结石取净率98.68%,术中未发生胆道出血、胆汁瘤等并发症,75例结石取净患者术后随访69例,失访6例,结石复发11例,复发率15.94%。41例"管状狭窄"行胆道球囊扩张术,结石取净37例,结石取净率90.24%,术中发生胆道出血5例,胆汁瘤1例,并发症发生率14.63%;37例结石取净患者术后随访35例,失访2例,结石复发13例,复发率37.14%。17例"门缝样狭窄"患者,结石取净14例,结石取净率82.35%,术中发生胆道出血2例,并发症发生率11.76%;14例结石取净患者术后随访13例,失访1例,结石复发4例,结石复发率30.77%。结论:胆管"膜状狭窄"行胆道镜下球囊扩张取石术结石复发率低,安全有效。胆管"管状狭窄"和"门缝样狭窄"行胆道镜下球囊扩张取石术结石残留率、并发症发生率、结石复发率较高,如患者身体能耐受,应优先选择肝切除术,完整切除狭窄胆管。

Objective:To discuss the therapeutic effect of biliary balloon dilatation in treating intrahepatic bile duct stones complicated by benign bile duct stricture.Methods:A retrospective analysis was given to the data of 134 cases of patients with intrahepatic bile duct stones complicated by benign bile duct stricture who received the treatment of biliary balloon dilatation at Shandong Provincial Third Hospital over the past 6 years.Among them,30 were bile duct stricture of the left lateral lobe,taking up 22.39%,25 were bile duct stricture of the left medial lobe,taking up 18.66%,26 were bile duct stricture of the right frontal lobe,accounting for 19.40%,47 were bile duct stricture of the right posterior lobe,accounting for 35.07%,6 were bile duct stricture of the caudate lobe,accounting for 4.48%.Stone removal,intraoperative complications and stone recurrence were taken as indexes of the assessment of therapeutic effect.Results:Among 76 cases of"membranous stricture"of the bile duct that received biliary balloon dilatation,75 had their stones removed,the removal rate being 98.68%,no hemobilia,biloma and other complications were observed during operation.Among the 75 cases,69 were included in the follow-up survey,6 lost,11 cases experienced recurrence of stones,the rate of recurrence being 15.94%.Among 41 cases of"tubular stricture"that received biliary balloon dilatation,37 had their stones removed,the removal rate being 90.24%,5 cases of hemobilia and 1 case of biloma occurred during operation,the rate of complications being 14.63%;among the said 37 cases,35 were included in the follow-up survey,2 lost,13 cases experienced recurrence of stones,the rate of recurrence being 37.14%.Among 17 cases of"crack-like stricture"that received biliary balloon dilatation,14 had their stones removed,the removal rate being 82.35%,2 cases of hemobilia occurred during operation,the rate of complications being 11.76%,among the said 14 cases,13 were included in the follow-up survey,1 lost;4 cases experienced recurrence of stones,the rate of recurrence being 30.77%.Conclusion:Cases of"membranous stricture"of the bile duct that received biliary balloon dilatation show low rate of recurrence of stones,which demonstrates the safety and efficiency of the treatment method.Cases o"f tubular stricture"and"crack-like stricture"that received biliary balloon dilatation,on the other hand,show higher rate of residual stones,rate of complications and rate of recurrence.Therefore,hepatectomy should be prioritized to remove the bile duct stricture completely if the patient is able to tolerate.