超声引导经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石  

Ultrasound guided-percutaneous transhepatic cholangioscopic one-stage lithotomy with rigid choledochoscope for hepatolithiasis

作　　者：李炳根[1] 梁璇坤 邱敏捷[3] 聂向阳[1] 彭永辉[1] 龚独辉[1] 谢志华[1] 莫宇轩[1] 李达强[1] 

机构地区：[1]南方医科大学附属何贤纪念医院普通外科,广州511400 [2]南方医科大学附属何贤纪念医院超声科,广州511400 [3]南方医科大学附属何贤纪念医院泌尿外科,广州511400

出　　处：《中华腔镜外科杂志（电子版）》2017年第2期85-88,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的探讨超声引导经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石的可行性及疗效。方法 2013年1月至2016年1月期间,南方医科大学附属何贤纪念医院的21例肝胆管结石患者,均采用超声引导经皮肝穿刺一期硬质胆道镜碎石术。结果 21例患者手术均成功,无中转手术。18例(85.7%)患者最终取净结石,其中1次结石取净者14例(66.7%)。手术时间(95.7±21.0)min,术中出血量(15.1±7.6)ml,住院时间(11.6±4.3)d。术后发生并发症4例,其中1例出现胆瘘并局部胆汁性腹膜炎,经超声定位穿刺置管引流后痊愈;2例出现右侧少量胸腔积液,1例出现右下肺盘状不张,均经过保守治疗后痊愈。无术后胆道感染或胆道出血,无死亡病例。所有患者均获得随访,随访8~44个月,4例(19.0%)出现结石复发。结论超声引导下经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石安全有效、创伤小,提高了碎石取石效率,缩短患者住院时间。Objective To analyze the feasibility and efficiency of ultrasound guided-pereutaneous transhepatic cholangioseopic （PTCS） one-stage lithotomy with rigid choledochoscope for the treatment of hepatnlithiasis. Methods From Jan. 2013 to Jan. 2016. Twenty one eases of hepatolithiasis patients were enrolled. All of them were treated by PTCS one-stage lithotomy with rigid choledoehoscope. Clinical data were collected and analyzed retrospectively. Results All surgeries were successful without conversion. All the stones were removed eventually in 85.7% （18/21）, 14 eases（66.7% ） achieved this clearance in one episode. The mean operation time was（95.7 ± 21.0） rain. Mean blood loss was（ 15.1±7.6） ml. Average hospital stay was（ 11.6 ± 4.3 ）d. Four patients suffered from mild to moderate complications. All of them were managed properly, with no major impact on the final outcome. All patients were followed-up for 8 to 44 months. 4 eases（ 19.0% ） of recurrences were noticed. Conclusions Ultrasound guided PTCS onestage lithotomy with rigid eholedoehoseope was a safe and feasible procedure. It was minimally invasive and highly efficient whicla result in shortening patients＇ hospital stay. Therefore it might be a worthy alternative for the treatment of hepatolithiasis.

关 键 词：肝胆管结石 经皮肝穿刺胆道造瘘 胆道镜 碎石术 

分 类 号：R657.4[医药卫生—外科学]