中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (11): 1295-1299.DOI: 10.19538/j.cjps.issn1005-2208.2024.11.21

• 论著 • 上一篇    下一篇

经皮经肝胆道造瘘取石术治疗复发性肝内胆管结石疗效研究

黄    鑫1，罗顺峰2，刘红枝1，黄起桢1，林科灿2，方国旭1，黄志东3，曾永毅1   

  1. 1福建医科大学孟超肝胆医院肝胆外科，福建福州350025；2福建医科大学附属第一医院肝胆外科，福建福州350005；3福州市闽清县总医院普通外科，福州闽清350800
  • 出版日期:2024-11-01 发布日期:2024-11-26


  • Online:2024-11-01 Published:2024-11-26

摘要： 目的    探讨经皮经肝胆道造瘘取石术（PTBF）在治疗复发性肝内胆管结石中的临床疗效。方法    回顾性分析福建医科大学孟超肝胆医院2021年1月至2023年6月收治的63例复发性肝内胆管结石病人的临床资料，所有病人按取石术式的不同分为外科手术组（44例）和PTBF手术组（19例）。比较两组病人的基线资料、围手术期相关指标变化值、手术情况等。结果    两组病人的性别、年龄、实验室指标、肝功能Child-Pugh分级及肝内胆管结石复杂程度等术前基线资料比较，差异均无统计学意义（P＞0.05）。外科手术组与PTBF手术组的结石取尽率差异无统计学意义（75.0% vs. 78.9%，P＞0.999）。外科手术组结石一次取尽率高于PTBF手术组，差异有统计学意义（93.9% vs. 6.7%，P＜0.001）。PTBF手术组术后白细胞计数、肝功能指标及术后并发症发生率均优于外科手术组，差异有统计学意义（P＜0.05）。PTBF手术组术前术后白细胞计数、血红蛋白、血小板计数、丙氨酸转氨酶、天冬氨酸转氨酶及凝血酶原时间变化值均小于外科手术组，差异有统计学意义（P＜0.05）。结论    PTBF手术治疗复发性肝内胆管结石的手术成功率及结石取尽率不劣于传统外科手术，且术后并发症发生率更低、创伤更小、恢复更快，可作为传统外科手术的重要补充。

关键词: 肝内胆管结石, 经皮经肝胆道造瘘取石术, 胆道外科手术, 临床疗效

Abstract: To explore the clinical efficacy of percutaneous transhepatic biliary fistula (PTBF) in treating recurrent intrahepatic bile duct stones. Methods    A retrospective analysis was conducted on the clinical data of 63 patients with recurrent intrahepatic bile duct stones treated at Mengchao Hepatobiliary Hospital of Fujian Medical University from January 2021 to June 2023. The patients were divided into the surgical group (44 cases) and the PTBF group (19 cases), according to different lithotomy methods. The baseline data, perioperative changes of parameters and surgery conditions were compared between the two groups. Results    There were no significant differences in preoperative baseline characteristics such as gender, age, laboratory indices, Child-Pugh classification of liver function, and complexity of intrahepatic bile duct stones between the two groups (P>0.05). The complete stone removal rate showed no significant difference between the surgical group and the PTBF group (75.0% vs. 78.9%, P＞0.999). The one-time complete stone removal rate in the surgical group was significantly higher than in the PTBF group, and the difference was statistically significant(93.9% vs. 6.7%, P<0.001). Postoperatively, the PTBF group had better outcomes regarding white blood cell count, liver function indices, and complication rates than the surgical group, with significant differences (P<0.05). The changes in pre- and post-operative white blood cell count, hemoglobin, platelet count, alanine amino-transferase, aspartate transaminase, and prothrombin time were smaller in the PTBF group than in the surgical group, with significant differences (P<0.05). Conclusion    PTBF is not inferior to traditional surgery in terms of surgical success rate and complete stone removal rate for recurrent intrahepatic bile duct stones. Additionally, PTBF has a lower complication rate, less trauma, and faster recovery, making it an important supplementary treatment to traditional surgery.

Key words: recurrent hepatolithiasis, percutaneous transhepatic biliary fistulation lithotripsy, biliary tract surgery, clinical effectiveness