经皮经肝胆道镜在复杂肝内外胆管结石治疗中的应用

Effect of percutaneous transhepatic choledochoscopy in the treatment of complex intrahepatic and extrahepatic bile duct stones

目的探讨经皮经肝胆道镜(PTCS)治疗复杂肝内外胆管结石的疗效与安全性。方法回顾性分析白银市第二人民医院2021年1月至2021年12月收治的120例复杂肝内外胆管结石患者的临床资料,其中男性74例,女性46例,年龄(53.3±2.4)岁。依据手术方案分成两组:开展常规开腹取石术的患者纳入对照组(n=60),开展PTCS的患者纳入观察组(n=60)。比较两组患者的术中出血量、手术时间、术后肛门排气时间、应激指标、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、并发症及疗效等。结果与对照组相比,观察组患者术后肛门排气时间[(1.80±0.25)d比(2.53±0.28)d]和手术时间[(1.62±0.24)h比(2.35±0.28)h]缩短,术中出血量减少[(51.21±8.23)ml比(119.21±8.29)ml],差异均具有统计学意义(均P<0.05)。与对照组术后各对应指标相比,观察组患者术后1 d的肾上腺素[(119.7±12.0)ng/ml比(130.5±14.2)ng/ml]、AST[(188.6±24.7)U/L比(201.7±28.5)U/L]、ALT[(70.02±2.42)U/L比(87.30±2.56)U/L]均降低,差异具有统计学意义(均P<0.05)。观察组患者的总有效率高于对照组[96.7%(58/60)比83.3%(50/60)],差异具有统计学意义(P=0.005)。观察组并发症发生率较对照组低[6.7%(4/60)比36.7%(22/60)],差异具有统计学意义(P=0.005)。结论与常规开腹取石术相比,PTCS对复杂肝内外胆管结石的疗效更优,应激反应更小,对肝功能影响较轻,且并发症发生风险更低。

Objective To evaluate the curative effect of percutaneous transhepatic choledoscopy(PTCS)in the treatment of complex intrahepatic and extrahepatic bile duct stones.Methods Clinical data of 120 patients with complex intrahepatic and extrahepatic bile duct stones admitted to Baiyin Second People's Hospital from January 2021 to December 2021 were retrospectively analyzed,including 74 males and 46 females,aged(53.3±2.4)years old.Patients were divided the control group(n=60)who underwent routine laparotomy and the observation group(n=60)who underwent PTCS.Perioperative outcomes,including the intraoperative blood loss,operation time,postoperative exhaust time,stress status,liver function index[serum level of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)]and postoperative complications of the two groups were compared.Results Compared with the control group,the observation group had a shorter operation time[(1.62±0.24)h vs.(2.35±0.28)h]and postoperative exhaust time[(1.80±0.25)d vs.(2.53±0.28)d],and a decreased intraoperative blood loss[(51.21±8.23)ml vs.(119.21±8.29)ml](all P<0.05).The serum levels of adrenaline[(119.7±12.0)ng/ml vs.(130.5±14.2)ng/ml],ALT[(70.02±2.42)U/L vs.(87.30±2.56)U/L]and AST[(188.6±24.7)U/L vs.(201.7±28.5)U/L]were lower in observation group one day after surgery(all P<0.05).The total effective rate in observation group was higher than that in control group[96.7%(58/60)vs.83.3%(50/60),P=0.005].The rate of complications was also lower in observation group[6.7%(4/60)vs.36.7%(22/60),P=0.005].Conclusion Compared to routine laparotomy,PTCS could be more feasible for complex intra-and extrahepatic bile duct stones,considering its minimal invasiveness,less stress reaction,enhanced postoperative recovery,less disturbance of liver function,and decreased complications.