经皮经肝胆道镜取石术在复发性胆总管结石中的应用研究

Application of percutaneous transhepatic cholangioscopic lithotomy in recurrent choledocholithiasis

目的:探讨经皮经肝胆道镜取石术治疗复发性胆总管结石的临床疗效。方法:收集2020年6月至2023年6月行胆道手术治疗的83例复发性胆总管结石患者的临床资料,其中40行经皮经肝胆道镜取石术(PTCS),43例行腹腔镜胆总管切开取石术(LCBDE),对比分析两组手术效果与术后恢复情况。结果:PTCS组成功完成39例,1例中转LCBDE,中转率2.5%(1/40)。两组一般资料、总手术时间、术中出血量、胆总管直径、结石数量、最大结石直径、术后胃肠道生活质量指数、术后除中性粒细胞以外的实验室检查结果、T管引流量(除第3天)、并发症发生率差异无统计学意义(P>0.05)。PTCS组超声定位以外的手术操作时间、第3年总手术时间、术后镇痛例数、术后恢复进食时间、疼痛评分、住院时间、术后住院费用、导管滑脱风险、术后中性粒细胞、术后第3天T管引流量少于LCBDE组(P<0.05)。结论:PTCS与LCBDE治疗复发性胆总管结石均是可行的,与LCBDE相比,PTCS在微创方面更具优势。

Objective:To explore the clinical efficacy of percutaneous transhepatic cholangioscopy(PTCS)for recurrent choledocholithiasis.Methods:Clinical data of 83 patients with recurrent choledocholithiasis who underwent biliary tract surgery between Jun.2020 and Jun.2023 were included.Among them,40 patients were treated with PTCS(PTCS group),and 43 cases were treated with l aparoscopic common bile duct exploration(LCBDE)as the LCBDE group.The surgical outcomes and postoperative recovery were compared between the two groups.Results:In PTCS group 39 surgeries were successfully completed,one case was converted to LCBDE with a conversion rate of 2.5%(1/40).There were no significant differences in general data,total operation time,intraoperative blood loss,common bile duct diameter,number of calculi,maximum stone diameter,postoperative gastrointestinal quality of life index,postoperative laboratory examination(except neutrophils),T-tube drainage volume(except the third day),and incidence of surgical complications b etween the two groups(P>0.05).The operation time(except ultrasound positioning),total operation time at the third year,number of postoperative analgesics,postoperative resumption of feeding time,pain score,hospital stay,postoperative hospitalization cost,risk of catheter slippage,postoperative neutrophils,and T-tube drainage volume on the third postoperative day in PTCS group were less than those in LCBDE group(P<0.05).Conclusions:PTCS and LCBDE are both feasible in treatment of recurrent choledocholithiasis.C ompared with LCBDE,PTCS has more advantages in minimally invasive aspect.