B超引导下经皮穿刺胆道造瘘气压弹道碎石取石治疗肝内外胆管结石患者疗效分析  

B-ultrasound-guided percutaneous cholangiostomy pneumatic lithotripsy in treatment of patients with intra-and extrahepatic bile duct stones

作　　者：王运成 潘正故 翟刚 岑川 Wang Yuncheng;Pan Zhenggu;Zhai Gang(Department of General Surgery,Baise People's Hospital,First Affiliated Southwest Hospital,Guangxi Medical University,Baise 533000,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属西南医院/百色市人民医院普外科,广西壮族自治区百色市533000

出　　处：《实用肝脏病杂志》2019年第3期441-444,共4页Journal of Practical Hepatology

基　　金：2018年百色市科学研究和技术开发计划项目(编号:百科20184413)

摘　　要：目的探讨在B超引导下经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石患者的疗效,并对影响术后结石复发的因素进行分析。方法 2014年1月～2016年6月我院收治的106例肝内外胆管结石患者,其中57例接受经皮穿刺胆道造瘘气压弹道碎石取石术,另49例接受腹腔镜胆道探查取石术。术后随访2年,采用Logistic回归分析影响术后结石复发的相关因素。结果胆道造瘘气压弹道碎石取石术治疗患者住院时间、住院费用、术中出血量和手术时间分别为(5.2±1.7) d、(7321.5±528.3)元、(20.4±4.8) m L和(62.5±14.8) min,显著短于或少于腔镜治疗组【分别为(8.7±2.2)d、(10426.4±1032.5)元、(25.7±5.1) m L和(71.7±15.3) min,P<0.05】;胆道造瘘气压弹道碎石取石术治疗患者结石完全清除率为84.2%,显著高于腔镜治疗组(67.3%,P<0.05);胆道造瘘气压弹道碎石取石术治疗患者结石复发率为1.8%,显著低于对照组(20.4%,P<0.05);Logistic回归分析显示,结石数目、结石直径和手术方式为影响肝内外胆管结石患者术后结石复发的危险因素。结论采用经皮穿刺胆道造瘘气压弹道碎石取石术治疗肝内外胆管结石经济、安全、有效,值得临床进一步验证。Objective To investigate the efficacy of B-ultrasound-guided percutaneous cholangiostomy pneumatic lithotripsy in treatment of patients with intra-and extrahepatic bile duct stones. Methods 106 patients with intrahepatic and extrahepatic bile duct stones were recruited in our hospital between January 2014 and June 2016,and 57 patients received percutaneous biliary fistula pneumatic lithotripsy(observation group) and 49 received laparoscopic biliary exploration therapy (control group). All patients were followed-up for two years and the factors affecting postoperative recurrence of stones were analyzed by Logistic regression. Results The hospitalization stay,medical cost,intraoperative blood loss and operation time in the observation group were(5.2±1.7) d,(7321.5±528.3) yuan,(20.4±4.8) mL and(62.5±14.8) min,significantly less or shorter than [(8.7±2.2) d,(10426.4±1032.5) yuan,(25.7±5.1) mL and (71.7±15.3) min,P<0.05] in the control;the complete stone clearance rate in the observation group was 84.2%,significantly higher than 67.3%(P<0.05) in the control;the stone recurrence rate in the observation group was 1.8%,significantly lower 20.4%(P<0.05) in the univariate control;and multivariate Logistic analysis showed that the number of stones, the diameter of stones and surgical methods were the independent factors affecting stone recurrence after operation. Conclusion Percutaneous puncture and pneumatic ballistic lithotripsy is efficacious in the treatment of patients with intrahepatic and extrahepatic bile duct stones, which warrants further investigation.

关 键 词：肝内外胆管结石 经皮穿刺胆道造瘘气压弹道碎石取石术 腹腔镜胆道探查取石术 治疗 

分 类 号：R657.42[医药卫生—外科学]