Ⅰ期经皮经肝胆道造瘘胆道镜取石术治疗肝胆管结石病的临床疗效  

Clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one⁃step biliary fistulation for the treatment of hepatolithiasis

作　　者：吴琛 游伟 张龙 李东华 姚爱华 Wu Chen;You Wei;Zhang Long;Li Donghua;Yao Aihua(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院肝胆中心,210029

出　　处：《中华消化外科杂志》2020年第8期843-848,共6页Chinese Journal of Digestive Surgery

基　　金：江苏省六大人才高峰基金资助项目(2015⁃WSW⁃038)。

摘　　要：目的:探讨Ⅰ期经皮经肝胆道造瘘胆道镜取石术(PTCSL-OBF)治疗肝胆管结石病的临床疗效。方法:采用回顾性描述性研究方法。收集2017年3月至2019年12月南京医科大学第一附属医院收治的59例肝胆管结石病患者的临床病理资料;男16例,女43例;中位年龄为60岁,年龄范围为16~84岁。所有患者行PTCSL-OBF。观察指标:(1)手术及术后情况。(2)随访情况。(3)特殊病例介绍。采用门诊和电话方式进行随访,了解术后结石相关症状再现情况、结石复发情况和生存情况。随访时间截至2019年12月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。结果:(1)手术及术后情况:59例患者均成功施行PTCSL-OBF。59例患者中,建立单条窦道48例,2条窦道8例,3条窦道2例,4条窦道1例。59例患者共行106次胆道镜取石术,其中取石1次20例,取石2次31例,取石3次8例。59例患者中,14例术后有结石残留,45例取尽结石,结石取尽率为76.3%(45/59)。59例患者住院时间为24 d(3~88 d)。59例患者中,11例术后发生并发症(14例次),总体并发症发生率为18.6%(11/59)。14例次并发症中,胸腔积液合并感染4例次,肝脓肿2例次,腹腔积液2例次,术中低血压感染性休克2例次,出血2例次,结肠穿孔1例次,胆汁漏1例次。所有患者并发症予以穿刺引流、抗感染、止血等对症支持治疗后治愈。(2)随访情况:59例患者均获得随访,随访时间为1~34个月,中位随访时间为18个月。59例患者中,9例结石复发,复发率为15.3%(9/59),17例出现术后结石相关症状,发生率为28.8%(17/59)。45例取尽结石患者中,6例结石复发,复发率为13.3%(6/45),14例出现术后结石相关症状,发生率为31.1%(14/45)。14例术后有结石残留患者中,3例结石复发,复发率为21.4%(3/14),3例出现术后结石相关症状,发生率为21.4%(3/14)。随访期间,59例患者中,7例死亡,其中2例死亡原因为胆道肿瘤,5例为肝硬化�Objective:To investigate the clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation(PTCSL-OBF)for the treatment of hepatolithiasis.Methods:The retrospective and descriptive study was conducted.The clinicopathological data of 59 patients with hepatolithiasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2017 to December 2019 were collected.There were 16 males and 43 females,aged from 16 to 84 years,with a median age of 60 years.All patients underwent PTCSL-OBF.Observation indicators:(1)surgical and postoperative situations;(2)follow-up;(3)introduction of special cases.Follow-up using outpatient examination and telephone interview was performed to detect the hepotolithiasis-related symptoms,recurrence of hepatolithiasis,and survival of patients up to December 2019.Measurement data with skewed distribution were represented as M(range).Count data were represented as absolute numbers or percentages.Results:(1)Surgical and postoperative situations:59 patients underwent PTCSL-OBF successfully.Of the 59 patients,48 cases had 1 biliary sinus tract,8 cases had 2 biliary sinus tracts,2 cases had 3 biliary sinus tracts and 1 case had 4 biliary sinus tracts.A total of 106 times of cholangioscopic lithotripsy procedure were performed in the 59 patients,including 20 cases with once of cholangioscopic lithotripsy procedure,31 cases with twice of cholangioscopic lithotripsy procedure and 8 cases with 3 times of cholangioscopic lithotripsy procedure.Among the 59 patients,14 cases were diagnosed with residual stones after operation,45 cases had stones removed completely with the stones removal rate of 76.3%(45/59).The duration of hospital stay of the 59 patients were 24 days(range,3-88 days).Of the 59 patients,11 cases had 14 times of postoperative complications.The total incidence of complications was 18.6%(11/59).Among the 14 times of complications,there were 4 times of pleural effusion combined with infection,2 times of liver absc

关 键 词：胆道良性疾病 胆石症 肝胆管结石病 经皮经肝胆道镜取石 技术要点 并发症 

分 类 号：R657.42[医药卫生—外科学]