经皮肝穿刺胆管造瘘取石术治疗复杂性肝胆管结石

Percutaneous transhepatic cholangiolithotomy for complicated hepatolithiasis

目的:探讨经皮肝穿刺胆管造瘘电子胆道镜取石术治疗复杂性肝内胆管结石的疗效及优势。方法:选取2018年1月至2020年6月收治的89例复杂性肝内胆管结石患者作为研究对象,根据手术方式分为对照组(n=44)与研究组(n=45),对照组行开腹胆总管切开探查取石术,研究组行经皮肝穿刺胆管造瘘电子胆道镜取石术,对比分析两组手术指标、临床疗效、并发症、结石残留率及复发率。结果:研究组手术时间、切口长度、术中出血量、术后排气时间、住院时间均优于对照组,差异有统计学意义(P<0.05);研究组术后优良率高于对照组(86.7%vs.59.1%,P<0.05),术后并发症发生率、结石残留率、结石复发率均低于对照组(P<0.05)。结论:经皮肝穿刺胆管造瘘电子胆道镜取石术治疗复杂性肝内胆管结石具有出血少、术后并发症少、康复快、术后结石残留率、复发率低的优点,是安全、有效、重复性高的治疗方案,值得推广应用。

Objective:To explore the efficacy and advantages of percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)in the treatment of complicated intrahepatic bile duct stones(IHS).Methods:From Jan.2018 to Jun.2020,207 patients with complex IHS were selected as the research objects.According to the different surgical methods,they were divided into control group(n=44)and study group(n=45).The control group underwent open common bile duct exploration,and the study group used PTCSL,the surgical indicators,clinical efficacy,complications,residual stone rate and recurrence rate of the two groups were analyzed and compared.Results:The operation time,incision length,intraoperative blood loss,postoperative exhaust time and hospital stay in the study group were less than those in the control group(P<0.05).The postoperative excellent and good rate of the study group was higher than that of the control group(86.7%vs.59.1%,P<0.05).The incidence of postoperative complications,stone residual rate and recurrence rate in the study group were significantly lower than those in the control group(P<0.05).Conclusions:PTCSL in the treatment of complex IHS has advantages of few blood loss and postoperative complications,rapid recovery,low rate of postoperative residual calculi and recurrence.It is a safe,effective and reproducible treatment scheme,and is worthy of popularization and application.