经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石的近远期疗效  

Short and long term results of percutaneous transhepatic cholangioscopic lithotomy in the treatment of intrahepatic duct stones

作　　者：徐恕[1] 张剑权[1] 符国珍[1] 吕明[1] 周帅[1] 

机构地区：[1]中南大学湘雅医学院附属海口医院肝胆外科,海口570208

出　　处：《中华普通外科杂志》2016年第3期212-214,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石的疗效.方法 采用经皮肝穿刺胆管造瘘电子胆道镜取石治疗肝内胆管结石38例. 结果 38例均成功实施经皮肝穿刺胆管造瘘电子胆道镜取石术.近期疗效显示,结石清除率84.2％,平均取石次数（2.6±0.9）次,经皮肝扩张瘘道直径平均（18.4±0.6）F,从经皮肝穿刺造瘘到取石平均需（7.2±0.7）d.平均手术时间为（68±20） min,术中出血量（20±13）ml,住院时间（4±2）d.结石完全清除的32例患者1.5年随访复发率为37.5％ （12/32）,1例出现胆汁性肝硬化,有结石残留的患者复发率为83.8％（5/6）,1例出现胆汁性肝硬化.结论 经皮肝穿刺胆管造瘘电子胆道镜取石术在治疗首次肝内胆管结石、多次胆道术后复发肝内胆管结石或残留肝内胆管结石方面均是安全、有效、易重复的方法.具有微创、出血少、术后疼痛轻、并发症少、术后恢复快等优点.Objective To explore the short and long term curative effects of percutaneous transhepatic cholangioscopic lithotomy （PTCSL） in the treatment of intrahepatic stone （IHS）.Methods 38 IHS patients were enrolled,who were treated with PTCSL between January 2008 and July 2013.Results PTCSL was successfully completed in all the 38 IHS cases.Stone clearance rate was 84.2% and the average episode of stone removal was （2.6 ± 0.9） times.Average diameter of percutaneous transhepatic fistula was （18.4 ± 0.6） F and the average time from percutaneous transhepatic puncture and fistulization to cholangioscopic lithotomy was （7.2 ± 0.7）d.The average operation time was （68 ± 20） min,intraoperative blood loss was （20 ± 13） ml,and hospitalization was （4 ± 2） days.The hepatolith recurrence rate in patients with stones completely removed was 37.5% （12/32）,and 1 case developed into biliary cirrhosis.Patients with calculi residual suffered from higher hepatolith recurrence rate of 83.8% （5/6）,with biliary cirrhosis found in 1 case.Conclusions PTCSL is safe and effective in treating primary IHS,which is indicated in multiple recurrent IHS especially in after biliary surgery patients.It has the advantages of minimally invasion,less bleeding,less postoperative pain,less complications,and fast postoperative recovery.

关 键 词：胆结石 腹腔镜 经皮肝胆道造瘘术 

分 类 号：R657.42[医药卫生—外科学]