一次性经皮经肝胆道硬镜取石与ERCP治疗胆总管结石的临床研究  

One stage percutaneous transhepatic rigid choledochoscope lithotomy ( PTCSL) vs ERCP plus EST for choledocholithiasis

作　　者：方天翎[1] 刘衍民[1] 刘安重[2] 文辉清[2,3] 朱灿华 李君[1] Fang Tianling;Liu Yarunin;Liu Anzhong;Wen Huiqing;Zhu Canhua;Li Jun(Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China;Department of General Surgery, Center of Minimally Invasive Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China)

机构地区：[1]广州医科大学附属第一医院肝胆胰外科,510120 [2]广州医科大学附属第一医院微创外科中心普通外科,510230 [3]南方医科大学第五附属医院肝胆外科,广州从化510900

出　　处：《中华普通外科杂志》2019年第8期679-681,共3页Chinese Journal of General Surgery

基　　金：广东省科技计划项目(2014A020212515);东莞市社会科技发展(重点)项目(2018507150401634).

摘　　要：目的探讨经皮经肝路径胆道硬镜取石(percutaneous transhepatic choledochoscope lithotomy, PDCSL)、内镜逆行性胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)取石治疗胆总管结石的临床疗效。方法回顾性分析2010年1月至2015年12月我院收治的92例胆总管结石患者,分别采用一次性经皮经肝穿刺扩张胆管鞘管造痿+胆道硬镜取石(n = 23).ERCP内镜取石5=69),观察两组的临床疗效、并发症等。结果PDCSL组一次取石成功率100% o ERCP组一次取石成功率72. 46%、最终总成功率82. 60%,结石残留12例患者中5例转外科手术。两组患者术中出血分别为(20.6±4.6)ml、(3.0±0.3)ml,平均住院时间6.8、7 do PDCSL术后并发症以出血、胆道感染为主,ERCP并发症为术后胰腺炎、出血、胆道感染,两组并发症率为30.43%。观察期内两组复发率13. 04%。结论PDCSL治疗胆总管结石安全、疗效显著、并发症少、恢复快,特别适合大结石和既往有胆道手术史的患者。Objective To investigate the curative effect on patients with choledocholithiasis by percutaneous transhepatic rigid choledochoscope lithotomy ( PTCSL ) vs endoscopic retrograde cholangiopancreatography ( ERCP) plus EST. Methods From Jan 2010 to Dec 2015, 92 cases of choledocholithiasis were treated by one-stage PTCSL (n = 23 ) vs ERCP ( n = 69 ). The curative effects and postoperative complications in two groups were observed and analyzed. Results In PTCSL group, the complete stone clearance at one-time achieved in all 23 cases ( 100%). While in ERCP group stone clearance was achieved in 72. 46% cases at first attempt and the final clearance rate was 82. 60%, leaving 12 cases with residual stones and among those 12 cases 5 cases were converted to surgical operation. The average intra-operative hemorrhage in two groups was (20. 6 ± 4. 6 ) ml vs (3. 0 ± 0. 3 ) ml, and the average hospital stay after operation was 6. 8 d and 7 d respectively. The post-operative complications ( 30. 43%) and stone recurrence (13. 04%) were similar in the two groups. Conclusions PTCSL is safe, effective, and more suitable to patients with large stones and those with a history of biliary surgeries.

关 键 词：胆总管结石 胰胆管造影 内窥镜逆行 括约肌切开术 内窥镜 

分 类 号：R657.42[医药卫生—外科学]