日间胆道镜手术治疗胆道术后残余结石临床疗效  

Clinical efficacy of day-case choledochoscopy in treatment of residual calculi after biliary tract surgery

作　　者：吉琳 吝怡 李益行 樊茜 陈雯雯 赵泓玮 徐庶钦 雷凤萍 王方舟 李露新 常凯曦 张至轩 周古翔 吕毅[1,2] 严小鹏[1,2] Ji Lin;Lin Yi;Li Yixing;Fan Xi;Chen Wenwen;Zhao Hongwei;Xu Shuqin;Lei Fengping;Wang Fangzhou;Li Luxin;Chang Kaixi;Zhang Zhixuan;Zhou Guxiang;Lyu Yi;Yan Xiaopeng(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;National-Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Qide College of Xi'an Jiaotong University,Xi'an 710061,China;Zonglian College of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061 [2]西安交通大学第一附属医院精准外科与再生医学国家地方联合工程研究中心,710061 [3]西安交通大学启德书院,710061 [4]西安交通大学宗濂书院,710061

出　　处：《中华肝脏外科手术学电子杂志》2020年第4期352-355,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81700545);陕西省自然科学基础研究计划(2017JQ8021);中央高校基本科研业务费专项资金(xjj2018jchz14)。

摘　　要：目的探讨日间胆道镜取石在胆道手术后残余结石患者治疗中的安全性和疗效。方法 回顾性分析2018年10月至2019年9月在西安交通大学第一附属医院收治的118例胆道术后残余结石患者临床资料。其中男45例,女73例;平均年龄(59±14)岁。首次开腹手术80例,腔镜手术26例,经皮经肝胆道镜术12例。患者均签署知情同意书,符合医学伦理学规定。患者入院24 h内完成入院、胆道镜取石及出院。分析日间胆道镜治疗患者手术及术后并发症发生情况。结果日间胆道镜取石均于原胆道手术后6~12周实施。行胆道镜取石共162例次,其中1次性结石取净率79.7%(94/118),2次结石取净率为11.9%(14/118),取石3次及以上者8.5%(10/118)。单纯采用网篮取石90例,先碎石再取石27例,球囊扩张后再取石1例。整体日间手术完成率达98.8%(160/162)。2例术后出现急性胆管炎,积极治疗后痊愈,无发生胆道出血和窦道损伤。结论日间胆道镜治疗胆道术后残余结石疗效确切,安全性高,患者住院周期短,可纳入日间手术流程。Objective To explore the safety and efficacy of day-case choledochoscopy in the treatment of patients with residual calculi after biliary tract surgery.Methods Clinical data of 118 patients with residual calculi after biliary tract surgery admitted in the First Affiliated Hospital of Xi'an Jiaotong University from October 2018 to September 2019 were retrospectively analyzed.Among them,45 patients were male and 73 female,with a mean age of(59±14)years.For the primary surgery,80 cases underwent open surgery,26 cases laparoscopic surgery and 12 cases percutaneous transhepatic choledochoscopy.The informed consents of all patients were obtained and the local ethical committee approval was received.The patients were admitted in hospital and underwent choledochoscopy and then discharged within 24 h.Operations and postoperative complications of the patients undergoing day-case choledochoscopy were analyzed.Results Day-case choledochoscopy was performed in the patients 6 to 12 weeks after the primary bile duct surgery.162 times of choledochoscopic lithotripsy were performed,with once-through stone removal rate 79.7%(94/118),twice stone removal rate 11.9%(14/118)and≥3 times stone removal rate 8.5%(10/118).Basket extraction was performed in 90 cases,extraction after lithotripsy was performed in 27 cases and extraction after balloon expansion was used in 1 case.The overall completion rate of day-case surgery reached 98.8%(160/162).2 cases suffered from acute cholangitis after operation and recovered after active treatments.No biliary bleeding and sinus injury occurred.Conclusions Day-case choledochoscopy in treating residual calculi after biliary tract surgery is effective,safe.It can be incorporated into the day-case surgeries for a short hospitalization period.

关 键 词：胆结石 胆道镜 日间手术 

分 类 号：R657.4[医药卫生—外科学]