经皮经肝一期胆道造瘘取石术与分期经皮经肝胆道镜取石术治疗复杂肝胆管结石的疗效比较

A retrospective comparative study on the therapeutic effect of one-stage means two-stage percutaneous transhepatic biliary fistulation lithotripsy in treatment of complex hepatolithiasis

目的比较经皮经肝一期胆道造瘘(PTOBF)取石术与分期经皮经肝胆道镜取石术(PTCSL)治疗复杂肝胆管结石的临床效果。方法回顾分析广州医科大学附属第一医院2013年9月至2018年6月收治的145例复杂肝胆管结石患者资料,其中男性60例,女性85例,年龄(56.5±14.1)岁,年龄范围21~91岁。依据瘘道建立的方式分为:PTOBF取石组(n=94)和分期PTCSL组(n=51)。比较两组一次穿刺成功率、一次瘘道扩张成功率、取石手术时间、手术中转率(经皮经肝胆道镜手术中转为腹腔镜、开腹手术)、术后并发症(包括脱管)、结石残留率、结石复发率等。结果PTOBF取石组取石手术时间(105.8±43.6)min、一次穿刺成功率73.4%(69/94)、一次瘘道扩张成功率93.6%(88/94)、手术中转率0,优于分期PTCSL组的(130.0±70.0)min、54.9%(28/51)、68.6%(35/51)、13.7%(7/51),差异有统计学意义(均P<0.05)。PTOBF取石组结石残留率17.0%(16/94)、结石复发率14.9%(14/94),分期PTCSL组为15.7%(8/51)、17.6%(9/51),两组比较差异均无统计学意义(均P>0.05)。PTOBF取石组术后总并发症发生率7.4%(7/94),分期PTCSL组为39.2%(20/51),两组比较差异有统计学意义(χ^(2)=22.02,P<0.001)。其主要差异在脱管率,PTOBF取石组脱管率2.1%(2/94),低于分期PTCSL组27.4%(14/51),差异有统计学意义(χ^(2)=21.59,P<0.001)。结论PTOBF取石术与分期PTCSL治疗复杂肝胆管结石均安全、有效,但与分期PTCSL相比,PTOBF取石术时间更短、导管脱落率及手术中转率更低。

Objective To compare the therapeutic effect of one-stage versus two-stage percutaneous transhepatic biliary fistulation lithotripsy in treatment of complex hepatolithiasis.Methods A retrospective study was conducted on 145 patients with complex hepatolithiasis who were treated at the First Affiliated Hospital of Guangzhou Medical University between September 2013 and June 2018.There were 60 males and 85 females,aged 21 to 91(56.5±14.1)years.According to the method of fistula establishment,patients were divided into the percutaneous transhepatic one-step biliary fistulation(PTOBF)group(n=94)or the two-stage percutaneous transhepatic choledochoscopic lithotripsy(PTCSL)group(n=51).The success rates of one-time puncture and fistula dilation,operation time of lithotripsy,operative conversion rate(PTCSL was converted to laparotomy and laparoscopic surgery),postoperative complications(including catheter dislodgement),residual stone rates and stone recurrence rates were compared between groups.Results In the PTOBF group,operation time(105.8±43.6)min,success rate of one puncture 73.4%(69/94),and success rate of one fistula dilation 93.6%(88/94),the rate of operative conversion 0.All these results were significantly better than the corresponding results of the two-stage PTCSL group of(130.0±70.0)min,54.9%(28/51),68.6%(35/51),and 13.7%(7/51)respectively(all P<0.05).There were no significant differences in stone residual rate[17.0%(16/94)vs.15.7%(8/51)]and stone recurrence rate[14.9%(14/94)vs.17.6%(9/51)]between groups(both P>0.05).The postoperative complications rate was 7.4%(7/94)in PTOBF group,which was 39.2%(20/51)in two-stage PTCSL group(χ^(2)=22.02,P<0.001).The catheter dislodgement rate of PTOBF group was 2.1%(2/94),lower than that of two-stage PTCSL group 27.4%(14/51),the difference was statistically significant(χ^(2)=21.59,P<0.001).Conclusion One-stage PTOBF and two-stage PTCSL were both safe and effective in treatment of complex hepatolithiasis.However,PTOBF had shorter operative times,lower catheter dislodgement and operative conversion rates than PTCSL.