中国实用外科杂志

中国实用外科杂志

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经皮经肝胆道镜硬镜碎石术治疗肝内胆管结石194例临床疗效分析

蒋小峰，张大伟，卢海武，温子龙，郑    强，刘颂航，杨学伟，曹良启，薛    平   

  1. 广州医科大学附属第二医院肝胆胰外科，广东广州510260
  • 出版日期:2017-08-01 发布日期:2017-07-25

  • Online:2017-08-01 Published:2017-07-25

摘要：

目的    探讨经皮经肝胆道镜（percutaneous transhepatic cholangioscopy，PTCS）硬镜碎石术治疗肝内胆管结石的疗效。方法    回顾分析2008-02-01—2016-12-31广州医科大学附属第二医院肝胆外科行PTCS硬镜碎石术的194例肝内胆管结石病人资料。分为二种方法：一步法为同时行肝内胆管穿刺和胆道镜碎石取石术，而二步法为先行肝内胆管穿刺置管引流及胆汁培养后，3～5 d后择期行胆道镜碎石取石术。结果    所有病人均成功进行PTCS硬镜碎石术。其中一步法28例（14.4%），二步法166例（85.6%）。手术时间（45.0±8.0）min。用水量为（6000.0±500.0）mL。结石清除情况：完全清除81例（41.8%）；非完全清除113例（58.2%），其中109例二级胆管分支内无残留结石。 术后发生胆道感染13例（6.7%），出血5例（2.6%）。13例胆道感染病例中有2 例并发感染性休克，其中1例出现多器官功能衰竭，最终临床死亡，其余病例经保守治疗后均治愈。162例（83.5%）病人获得随访，总体结石复发率为29.6%（48/162）。结论    PTCS硬镜碎石术对经过选择的肝内胆管结石病例有一定治疗效果，适当辅助使用软镜可能更好地减少胆道残石。二步法较一步法可能减少严重并发症的发生。

关键词: 经皮经肝胆道镜, 硬质胆道镜, 肝内胆管结石

Abstract:

Clinical effective analysis of percutaneous transhepatic cholangioscopic lithotrip by rigid choledochoscopy for 194 patients with intrahepatic stones        JIANG Xiao-feng, ZHANG Da-wei, LU Hai-wu, et al. Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260，China
Corresponding author:XUE Ping, E-mail:drxueping@medmail.com.cn
Abstract    Objective    To investigate the clinical application of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for intrahepatic stones. Methods    The clinical data of 194 patients with complicate intrahepatic stone performed PTCSL between February 1, 2008 and December 31, 2016 in Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. The procedure was divided into two groups: one step procedure percutaneous transhepatic cholangial drainage and percutaneous transhepatic cholangioscopy were performed simultaneously; Two step procedure percutaneous transhepatic cholangioscopy was performed 3-5 days after percutaneous transhepatic cholangial drainage. Results    All the patients were successfully performed by percutaneous transhepatic cholangioscopy. The one step procedure was performed in 28 patients （14.4%），while two step procedure 166 patients（85.6%）. Operation time was（45.0±8.0）min. Saline solution used for rinse was（6000.0±500.0）mL. The stone clearance status：intrahepatic stones were all removed in 81 patients（41.8%）. Incomplete removal was achieved in 113 patients (58.2%), of which 109 patients of secondary bile duct branch without residual stones. Postoperative complications included 13 patients（6.7%） with biliary tract infection and 5 patients （2.6%） with bleeding. Two patients developed into infection shock and one patient died of multiple organ failure. One hundred and sixty-tow patients (83.5%) were followed up, and the overall recurrence rate for hepatolithiasis in patients who underwent PTCS therapy was 29.6%（48/162）. Conclusion    PTCSL is effective in the treatment of selected patients with intrahepatic bile duct stones. Combination of stiff and soft cholangioscopy can reduce the possibility of retaining stones after operation. Compared with one step procedure, two step procedure may result in fewer serious complications.

Key words: percutaneous transhepatic cholangioscopy, rigid choledochoscopy, intrahepatic stones