经皮经肝Ⅰ期胆道造瘘取石术联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石  

Percutaneous transhepatic one-step biliary fistulation lithotomy combined with laparoscopic cholecystectomy for choledocholithiasis with gall stones

作　　者：朱灿华[1] 孙北望[1] 王平[1] 刘衍民[1] 罗燕君[1] 谢嘉奋 周兴华[1] Zhu Canhua;Sun Beiwang;Wang Ping;Liu Yanmin;Luo Yanjun;Xie Jiafen;Zhou Xinghua(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：《中华普通外科杂志》2021年第3期178-181,共4页Chinese Journal of General 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：目的探讨经皮经肝I期胆道造瘦(percutaneous transhepatic one-step biliary fistulation,PTOBF)取石术联合腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)治疗胆总管结石合并胆囊结石的临床应用价值。方法回顾性分析2012年7月至2018年6月期间广州医科大学附属第一医院收治的44例胆总管结石合并胆囊结石患者的临床资料,20例采用PT0BF取石术+LC手术,24例采用腹腔镜胆总管探查取石术(laparoscopic common bile duct exploration,LCBDE)+LC手术。观察两组的临床疗效、并发症。结果两组患者一期手术成功率均为100%。PT0BF取石术+LC组手术出血量、术后住院天数均优于LCBDE+LC组,差异有统计学意义(均P<0.05)。PT0BF取石术+LC组术后并发症发生率10.0%(2/20),观察期复发率10.0%(2/20),LCBDE+LC组术后并发症发生率8.3%(2/24),观察期复发率12.5%(3/24),差异无统计学意义(均P>0.05)。结论PT0BF取石联合LC术治疗胆总管结石合并胆囊结石是安全、有效的。Objective To evaluate the clinical value of percutaneous transhepatic one-step biliary flstulation(PTOBF)lithotomy plus laparoscopic cholecystectomy(LC)in the treatment of choledocholithiasis combined with cholecystolithiasis.Methods From Jul 2012 to Jun 2018,44 patients with cholecystolithiasis and choledocholithiasis were treated by PTOBF+LC(n=20)vs laparoscopic common bile duct exploration(LCBDE)+LC(n=24).Results The success rate of one-step operation in both groups was 100%.The average intra-operative hemorrhage and the average hospital stay after operation were higher in LCBDE+LC group(all P<0.05).The post-operative complication rate of PTOBF lithotomy+LC group was 10.0%(2/20),recurrence rate of observation period was 10.0%(2/20),while that of LCBDE+LC group was 8.3%(2/24),and 12.5%(3/24),the difference was not statistically significant(all P>0.05).Conclusion PTOBF lithotomy combined with LC is a safe,effective and feasible minimally invasive method for the treatment of choledocholithiasis combined with gall stones.

关 键 词：胆囊结石病 胆总管结石 腹腔镜手术 

分 类 号：R657.42[医药卫生—外科学]