超声引导经皮肝Ⅰ期胆道造瘘联合硬质胆道镜治疗复杂肝胆管结石  

The ultrasonic navigation technique in percutaneous transhepatic one-step biliary fistulation with rigid cholangioscopic lithotripsy for complicated hepatolithiasis

作　　者：朱灿华[1] 王平[1] 孙北望[1] 刘成成[1] 刘衍民[1] 周兴华[1] 高飞[1] 周大治[1] Zhu Canhua;Wang Ping;Sun Beiwang;Liu Chengcheng;Liu Yanmin;Zhou Xinghua;Gao Fei;Zhou Dazhi(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院肝胆外科,510120

出　　处：《中华肝胆外科杂志》2020年第2期103-107,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：广东省科技计划(2017ZC0222);广州市民生科技攻关计划(201803010065);广州市科技计划(201704020215)。

摘　　要：目的 探讨超声引导技术在经皮肝Ⅰ期胆道造瘘(PTOBF)联合硬质胆道镜取石术治疗复杂肝胆道结石的有效性及安全性。方法 回顾性分析2016年1月至12月广州医科大学附属第一医院施行PTOBF取石手术的肝胆管结石94例患者资料。所有患者在超声实时引导下经皮经肝胆管穿刺成功后,直接扩张窦道至14F,应用硬质胆管镜经鞘管进入胆管取石,观察患者穿刺成功率,并发症发生率,窦道扩张成功比,结石残留率,术中出血量,结石复发率等。结果 94例患者共行经皮肝胆管穿刺122例次,总穿刺成功率100%;扩张/穿刺成功率97.5%(119/122),术中出血量20(10,30) ml,手术并发症发生率9.6%(9/94),术后结石残留率13.8%(13/94),结石复发率14.9%(14/94)。结论 超声引导技术在PTOBF取石手术中的靶胆管穿刺、窦道扩张、硬质胆道镜取石等方面起重要作用,是一项安全、有效的技术,为复杂肝胆管结石的微创治疗提供了新方法,值得推广。Objective To study the efficacy and safety of percutaneous transhepatic one-step biliary fistulation(PTOBF)with rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis under the ultrasonic navigation technique.Methods In this retrospective study,PTOBF lithotripsy surgery was performed in 94 patients with hepatolithiasis under general anesthesia with tracheal intubation,and with percutaneous transhepatic puncture of targeted bile duct under ultrasonic navigation in The First Affiliated Hospital of Guangzhou Medical University.Biliary expanders were used along a guidewire to expand the sinus gradually until 14Fr to establish a fistulous channel.Lithotripsy was then performed through the channel by rigid cholangioscopy.The operation-related data were collected and analyzed,including puncture and fistula establishment success ratio,complication rate,intraoperative blood loss,residual and recurrence hepatolithiasis rates.Results 94 patients(total 122 patient-times)underwent PTOBF lithotripsy.There was no perioperative mortality.The overall puncture success rate was 100%,and the fistula/puncture rate was 91.5%(119/122).In 118 patients success was achieved in 2 time(96.7%).The complication rate was 9.6%(9/94).The average intraoperation blood loss were(24.9±21.3)ml.The residual calculus rate after therapy was 13.8%(13/94).All patients were followed-up for a period that ranged between 18 and 30 months.The recurrence rate was 14.9%(14/94).Conclusions Ultrasonic navigation technique plays an important role in bile duct puncture,sinus expansion and rigid cholangioscopic lithotripsy for treatment of complicated hepatolithiasis.PTOBF lithotripsy is a safe and effective procedure,which provides a new way in mini-invasive treatment for hepatolithiasis.It is worth generalizing.

关 键 词：超声 导航 经皮肝穿刺术 肝胆管结石 硬质胆道镜 

分 类 号：R657[医药卫生—外科学]