左肝管与右肝管入路PTOBF取石手术治疗Ⅱa型肝胆管结石的比较研究

Comparison between left and right approaches for PTOBF lithotripsy applied in type Ⅱa hepatolithiasis

目的对比左肝管、右肝管入路经皮经肝Ⅰ期胆道造瘘(PTOBF)取石手术治疗Ⅱa型肝胆管结石的效果。方法回顾性分析2018年1月至2020年12月在广州医科大学附属第一医院行PTOBF取石手术治疗的79例Ⅱa型肝胆管结石患者临床资料,其中男性38例,女性41例,年龄(52.9±14.0)岁。根据穿刺路径不同分为左肝管入路组(n=40)和右肝管入路组(n=39)。比较两组的即刻结石取净率、最终结石取净率、术中出血量、取石手术时间、术后住院时间、术后并发症(腹水、胆道感染等)、反应性胸水、胆道取石手术次数、靶胆管扩张直径等。结果右肝管入路组即刻结石取净率为51.3%(20/39),取石手术次数为(1.9±1.0)次,均优于左肝管入路组的22.5%(9/40)、(2.4±1.0)次,但术后住院时间为5(3,6)d,反应性胸水发生率为23.1%(9/39),高于左肝管入路组的3(2,6)d、2.5%(1/40),差异均具有统计学意义(均P<0.05)。两组在靶胆管扩张直径、术中出血量、最终结石取净率、取石手术时间、术后并发症等方面比较,差异均无统计学意义(均P>0.05)。结论PTOBF取石手术治疗Ⅱa型肝胆管结石的右肝管入路比左肝管入路的即刻结石取净率更高,取石手术次数更少,但应注意反应性胸水的发生。

Objective To compare the outcomes of percutaneous transhepatic one-step biliary fistulation(PTOBF)lithotripsy for typeⅡa hepatolithiasis performed via the left or right lobe.Methods A retrospective study was conducted on 79 patients with typeⅡa hepatolithiasis treated in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2020,including 38 males and 41 females,aged(52.9±14.0)years.All patients had received PTOBF lithotripsy in single channel and divided into left lobe group(n=40)and right lobe group(n=39)according to different puncture approaches.Clinical data in immediate and final stone clearance rate,operation time of lithotripsy,intraoperative blood loss,postoperative complications(ascites,biliary tract infection),postoperative hospitalization time,reactive pleural effusion rate,the number of lithotripsy procedures and target bile duct dilatation diameter were compared between the two groups.Results Compared with left lobe group,right lobe group had higher immediate stone clearance[51.3%(20/39)vs 22.5%(9/40)],less lithotripsy procedures[(2.4±1.0)vs(1.9±1.0)],but had longer postoperative hospitalization time[5(3,6)d vs 3(2,6)d]and higher reactive pleural effusion rate[23.1%(9/39)vs 2.5%(1/40)],the differences were all statistically significant(all P<0.05).No significant difference was found in target bile duct dilatation diameter,final stone clearance rate,intraoperative blood loss,postoperative complication rate,and operation time of lithotripsy(all P>0.05).Conclusions Compared to the left lobe approach,right lobe approach could be prioritized in PTOBF lithotripsy for typeⅡa hepatolithiasis,considering its higher immediate stone clearance and less lithotripsy procedures,but this surgical approach should pay attention to the occurrence of reactive pleural effusion.