硬质肾镜经T管窦道治疗肝胆管残留结石的临床研究  

Clinical Research of Rigid Nephroscope through T-tube Sinus in the Treatment of Patients with Residual Bile Duct Stones

作　　者：张升敏 巫鸿生 陈浩 王健 林波 杨建荣 吴佳勉 曹天生 

机构地区：[1]花都区人民医院普外科,广东广州510800

出　　处：《汕头大学医学院学报》2016年第4期210-212,共3页Journal of Shantou University Medical College

基　　金：广州市花都区科技计划资助项目(15-HDWS-015)

摘　　要：目的:评价硬质肾镜经T管窦道治疗肝胆管残留结石的可行性及临床效果。方法:肝胆管残留结石患者随机分为研究(硬质肾镜经T管窦道取石术)和对照(纤维胆道镜经T管窦道取石术)组,每组45例。对比两组围手术期临床指标、血清炎症因子、手术并发症率及生存质量。结果:研究组平均手术((100.9±40.7)min)和住院时间((7.9±2.3)d)比对照组((142.3±51.9)min,(9.7±2.5)d)短(P<0.001,P<0.005),治疗总费用((14 491.2±1 804.7)元)低于对照组(16 914.8±2 203.1)元)(P<0.001),一次性结石取净率(84.4%)高于对照组(64.4%)(P<0.05)。研究组手术并发症率(8.9%)显著低于对照组(28.9%)(P<0.05)。两组术前血清白细胞介素(IL)6、肿瘤坏死因子(TNF)α、C反应蛋白(CRP)及胃肠道生活质量指数(GIQLI)评分无统计学意义。研究组术后24 h血清IL-6((33.3±7.1)ng/L)、TNF-α((28.9±9.0)ng/L)、CRP((38.5±7.8)mg/L)低于对照组((48.2±11.1)ng/L,(50.2±13.1)ng/L,(51.8±8.9)mg/L)(P<0.001)。研究组术后8周GIQLI评分((123.0±9.8)分)高于对照组((118.6±10.5)分)(P<0.05)。结论:硬质肾镜经T管窦道治疗肝胆管残留结石手术创伤小,术后恢复快、并发症少、效果可靠。Objective：To evaluate the feasibility and clinical effect of rigid nephroscope through T-tube sinus in the treatment of patients with residual bile duct stones. Methods：The patients with residual bile duct stones were randomly divided into study（hard nephroscope through T-tube sinus lithotripsy）and control（choledochofiberscope through T-tube sinus lithotripsy）groups,45 cases in each group. The preoperative clinical indexes,serum inflammatory factors,operative complication rates and quality of life were compared. Results：The average operation time（（100.9±40.7）minutes）and hospital stay（（7.9±2.3）days）in the study group were shorter than those（（142.3±51.9）minutes,（9.7±2.5）days）in the control group（P〈0.001,P〈0.005）. The treatment cost（（14 491.2±1 804.7）yuan）was lower than that（（16 914.8±2 203.1） yuan）in the study group（P〈0.001）. The complete clearance of stones（84.4%）in the study group was higher than that（64.4%）in the control group（P〈0.05）. The operative complications（8.9%）in the study group was lower than that（28.9%）in the control group（P〈0.05）. No significant difference between two groups was found in preoperative serum interleukin（IL）6, tumor necrosis factor（TNF）α, C-reactive protein（CRP）and gastrointestinal quality of life index（GIQLI）score. The postoperative serum IL-6（（33.3±7.1）ng/L）,TNF-α（（28.9±9.0）ng/L）and CRP（（38.5±7.8）mg/L） within 24 hours in the study group were lower than those（（48.2±11.1）ng/L,（50.2±13.1）ng/L,（51.8±8.9）mg/L）（P〈0.001）in the control group. The postoperative GIQLI score（（123.0±9.8）points）in 8 weeks in the study group was higher than that（（118.6±10.5）points）in the control group（P〈0.05）. Conclusion：The small surgical trauma,postoperative rapid recovery,less complications,and reliable results inrigid nephroscope through T-tube sinus treatment of patients with residual bile duct stones.

关 键 词：硬质肾镜 T管 窦道 肝胆管 残留结石 

分 类 号：R657.42[医药卫生—外科学]