经皮胆道造瘘碎石取石术治疗肝内胆管结石患者疗效分析  

Percutaneous choledocholithotomy for the treatment of patients with intrahepatic bile duct stones

作　　者：邱军[1] 王雪清[1] 张波[1] 吕波[2] Qiu Jun;Wang Xueqing;Zhang Bo(Department of Hepatobiliary Surgery,Fifth People's Hospital,Chengdu 610000,Sichuan Province,China)

机构地区：[1]成都市第五人民医院肝胆外科,610000 [2]成都大学附属医院普外科

出　　处：《实用肝脏病杂志》2019年第5期744-747,共4页Journal of Practical Hepatology

摘　　要：目的探讨经皮胆道造瘘碎石取石术治疗肝内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2013年1月~2017年1月我院行经皮胆道造瘘取石治疗肝内胆管结石患者894例,在T管引流术后行经皮胆道造瘘碎石取石术治疗。术后行定期超声检查发现结石复发情况,应用Logistic回归分析影响患者术后结石复发的危险因素。结果在894例患者中,结石完全取尽者844例(94.4%);随访期间87例(9.7%)患者结石复发;单因素分析发现复发患者年龄≥60岁、胆结石最大直径≥1 cm、胆结石数目≥10个、存在胆管扩张、黄疸、胆汁细菌培养阳性和结石类型为胆色素结石或混合型结石比例显著高于未复发患者(均P<0.05),进一步行多因素分析显示,年龄≥60岁、胆结石最大直径≥1 cm和胆结石数目≥10个为影响患者术后结石复发的独立危险因素。结论经皮胆道造瘘碎石取石术治疗肝内胆管结石患者能取得良好的效果,取石安全有效,结石取尽率高。但对于年龄≥60岁、胆结石最大直径≥1 cm和胆结石数目≥10个有高危结石复发因素者,应密切随访,尽早发现,早期处理。Objective To investigate the efficacy of percutaneous choledocholithotomy for the treatment of patients with intrahepatic bile duct stones.Methods The clinical data of 894 patients with intrahepatic bile duct stones were analyzed between January 2013 and January 2017 in our hospital by retrospective cross-sectional study,and the percutaneous cholangiography and lithotripsy was performed after T tube drainage.All patients were followed-up for postoperative recurrence of stones by ultrasonography,and the risk factors of postoperative recurrence were analyzed by Logistic regression analysis.Results Out of the 894 cases,87 patients(9.7%)had recurrence of stones,and univariate analysis showed that the percentages of patients older than 60 years,the maximum diameters of gallstones greater than 1 cm,the numbers of gallstones more than 10,the bile duct dilatation,physical jaundice,the positive bile bacteria cultures and cholelithiasis or mixed stones in patients with recurrent stone were found be much higher than in those without(all P<0.05);further multivariate analysis demonstrated that the age≥60 years,the maximum diameter of gallstones≥1cm,and the number of gallstones≥10 cases were the independent risk factors for the recurrence of postoperative stones.Conclusion Percutaneous choledochotomy lithotripsy has a good efficacy in dealing with patients with intrahepatic bile duct stones,and the patients with high risk factors for postoperative bile duct stone recurrence should be followed-up regularly for early diagnosis and management in time.

关 键 词：肝内胆管结石 经皮胆道造瘘碎石取石术 复发 危险因素 

分 类 号：R65[医药卫生—外科学]