37例胆总管结石合并肝硬化病人经内镜取石治疗的临床分析  

Endoscopic for choledocholithiasispatients with liver cirrhosis

作　　者：肖定[1] 游建[1] 何鑫[1] 金鑫[1] 纪桂宝[1] 温松奇[1] 刘贤莉[1] Xiao Ding, You Jian, He Xin, Jin Xin , Ji Guibao , Wen Songqi , Liu Xianli.(Department of General Surgery, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, China)

机构地区：[1]华中科技大学同济医学院附属普爱医院肝胆胰疝外科,武汉430034

出　　处：《腹部外科》2017年第6期460-463,共4页Journal of Abdominal Surgery

摘　　要：目的探讨经内镜取石治疗胆总管结石合并肝硬化病人的临床疗效及安全性。方法回顾性分析武汉市普爱医院普外科2009年10月至2017年9月收治的成功接受内镜取石术病人资料,胆总管结石合并肝硬化病人37例为观察组,随机抽取同期接受内镜取石术诊治且无肝硬化病史的胆总管结石345例为对照组,对比分析术前肝硬化程度、术中内镜操作方法、并发症发生情况以及病死率。结果观察组术后并发症发生率为21.6%(8/37),较对照组的7.2%(25/345)明显增多。其中出血发生率为45.5%(5/11),较多发,且均为Child-Pugh B级和C级、采用内镜下十二指肠乳头括约肌切开术(EST)取石法者。结论胆总管结石合并肝硬化病人在接受内镜取石术治疗仍具有一定风险,严重并发症主要为上消化道出血,因此术前要积极改善其凝血功能,尽量降低Child-Pugh评分;十二指肠乳头球囊扩张术(EPBD)较EST对十二指肠乳头括约肌的损伤小、出血少,更适宜作为本类病人的内镜治疗方式。Objective To explore the clinical efficacy and safety of endoscopic for choledocholithiasis patients with liver cirrhosis. Methods A retrospective analysis was carried out on the choledocholithiasis patients undergoing endoscopic in Wuhan Puai Hospital from October 2009 to September 2017. Thirty-seven choledocholithiasis patients with liver cirrhosis successfully undergoing endoscopic in our hospital were selected as observation group. 345 choledocholithiasis patients without history of liver cirrhosis served as the control group. The degree of liver cirrhosis among the patients,operation methods,complications,intra-endoscopic mortality and post-endoscopic mortality were analyzed. Results The incidence of postoperative complications was 21. 6%（ 8/37） in the observation group,which was increased significantly as compared with the control group [7. 2%（ 25/345） ]. Among all complications,the most common one was bleeding[45. 5%（ 5/11） ]in patients with Child-Pugh B or C by EST method. Conclusions Endoscopic has a considerable risk for the choledocholithiasis patients with liver cirrhosis. The most serious complication is hemorrhage in upper gastrointestine. We should improve the blood coagulation function and minimize Child score before endoscopic. EPBD has less trauma to the sphincter of duodenal papilla and lower hemorrhage rat than endoscopic,which might be more suitable for choledocholithiasis patients with liver cirrhosis.

关 键 词：肝硬化 胆总管结石 并发症 

分 类 号：R657.3[医药卫生—外科学]