经皮胆道硬镜在治疗肝胆管结石近期、远期疗效的研究  

Study on short-term and long-term effects of PTCSL on hepatolithiasis

作　　者：王平[1] 陈小伍[2] 叶琛[1] 周子萱 刘衍民[1] 

机构地区：[1]广州医科大学附属第一医院肝胆外科,510120 [2]南方医科大学附属顺德第一人民医院

出　　处：《实用医学杂志》2014年第22期3579-3582,共4页The Journal of Practical Medicine

基　　金：2013年度广东省医学科研基金立项课题(数字医学技术在经皮肝胆道镜碎石(PTCSL)治疗肝胆管结石中的应用研究);(编号:A2013254)

摘　　要：目的:研究经皮胆道硬镜在治疗肝胆管结石近期、远期疗效。方法:采集2004年3月至2013年12月期间我们行手术治疗的170例肝胆管结石患者纳入研究。经皮肝胆道硬镜碎石术(A组)83例,腹腔镜探查取石术(B组)87例。比较两组患者一般临床资料、近期疗效和远期疗效指标。结果:两组患者在年龄、性别等方面进行比较,差异无统计学意义(P>0.05)。A组和B组的手术时间、术中输血量、术中出血量分别为(137.5±68.7)min,0 m L,(22.6±23.8)min,(201.7±195.7)m L和(223.2±51.4)min,(278.1±144.6)m L,差异有统计学意义(P<0.05)。A组的即刻结石残留率为2.4%、最终结石残留率4.8%、复发胆管炎4.8%;B组分别为18.4%、23.0%、23.0%,差异有统计学意义(P<0.05)。A组的结石复发率为12.0%与B组的22.9%差异无统计学意义(P>0.05),两组均无死亡病例。结论:经皮肝胆道硬镜治疗肝胆管结石安全、微创、有效,其短期疗效、远期疗效均优于腹腔镜探查取石术组。Objective To explore the short-term and long-term effects ofapplication of Percutaneous Transhepatic Cholangioscopic Lithotripsy on the treatment of hepatolithiasis. Methods Eighty-threecases of hepatolithiasis were treated with the PTCSL and the other 87eases were treated with the Laparoseopic exploration lithotomy.The general clinical parameters, curative effect in the near future and long-term curative effect were anlyzed. Results No significant differences were found between the two groups in the general clinical parameters（P 〉 0.05）. The operation time, intraoperative blood transfusion volume and intraoperatve blood soss in group A were significantly shorter than those in group B（P 〈 0.05, respectively）. The original calculi residual rate was 2.4%, the eventually calculi residual rate was 4.8% and the recurrent cholangitis was4.8% in the model of PTCSL （Group A）. The original calculi residual rate was 18.4%, the eventually calculi residual rate was 23.0% and the recurrent cholangitis was 23.0% in the model of Laparoscopic exploration lithotomy （Group B）, with significant difference between these two groups （P 〈 0.05）. The calculi recurrence rate of group A was 12.0%, the calculi recurrence rate of group B was 22.9%, withno significant difference between these two group （P 〉 0.05 ）. No patients died in each group. The results of complications showed thatthe incidence of residual calculi of group A was significantly lower than that of group B （P 〈 0.01）. Conclusions Compared with the model of Laparoscopic exploration lithotomy, the PTCSL was more safe, minimally invasive and effective. The short-term efficacy of the model of PTCSL was better than that of the model of Laparoscopic exploration lithotomy.

关 键 词：肝胆管结石 经皮肝穿刺联合硬镜 腹腔镜探查取石术 

分 类 号：R657.4[医药卫生—外科学]