经皮经肝一期硬质胆道镜联合二期电子胆道镜取石治疗弥漫型肝胆管结石病  

Percutaneous Transhepatic Rigid Cholangioscopy Combined With Second Stage Electronic Choledochoscopy in the Management of Diffuse Hepatolithiasis

作　　者：潘孟[1] 李敏朋[1] 俞渊[1] 常明 Pan Meng;Li Minpeng;Yu Yuan(Department of Hepatobiliary Surgery,The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, China)

机构地区：[1]广西中医药大学第一附属医院肝胆外科,南宁530023

出　　处：《中国微创外科杂志》2021年第6期531-534,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：广西重点研发计划(桂科AB17195071);广西自然科学基金(面上项目)(2020GXNSFAA238012)。

摘　　要：目的探讨经皮经肝一期硬质胆道镜联合二期电子胆道镜取石治疗弥漫型肝胆管结石病的可行性及疗效。方法2017年8月~2019年12月我科对18例有胆道手术史的弥漫型肝胆管结石病采用经皮经肝一期硬质胆道镜联合二期电子胆道镜取石治疗,观察结石残留情况、二期胆道镜取石次数、结石清除率、复发率等指标。结果18例均顺利完成经皮经肝一期扩张窦道胆管造瘘硬质胆道镜取石,无严重出血、脏器损伤及术后胆漏等并发症。18例均行二期电子胆道镜取石,其中胆道镜取石1次1例,2次4例,3次及以上13例,最终结石取净16例(88.9%)。18例中位随访时间18个月(3~26个月),16例取净结石者有2例复发,16例治疗效果为优,2例偶发胆管炎。结论经皮经肝一期硬质胆道镜联合二期电子胆道镜取石治疗有胆道手术史患者的弥漫型肝胆管结石病安全可行,近期疗效满意。Objective To investigate the feasibility and therapeutic effect of percutaneous transhepatic rigid cholangioscopy combined with second stage electronic choledochoscopy in the management of diffuse hepatolithiasis.Methods A total of 18 cases treated in our department from August 2017 to December 2019 were retrospectively included in this study.Percutaneous transhepatic rigid cholangioscopy and second stage electronic choledochoscopy were applied to all the cases.The residual stones,times of operation for stone clearance,rate of clearance and recurrence were observed.Results The first stage of percutaneous transhepatic rigid cholangioscopy with dilation and drainage of intrahepatic bile duct was successfully completed in all the 18 cases.No complications such as hemorrhage,vicersa injury or biliary leak were found.The stones were cleared by second stage electronic choledochoscopy after drainage.The times of applying electronic choledochoscope for the clearance of stones were 1 times(1 case,5.6%),2 times(4 cases,22.2%),and 3 times and more(13 cases,72.2%).Stones were total cleared in 16 out of 18 cases(88.9%).The medium of follow-up time was 18 months(range,3-26 months).In 16 cases of stone clearance,relapse was noted in 2 cases(12.5%).In all the cases,occasionally mild cholangitis occurs in 2 cases(11.1%)and the rest had favorable short-term outcomes.Conclusion Percutaneous transhepatic rigid cholangioscopy combined with second stage electronic choledochoscopy is a safe and practical option for diffuse hepatolithiasis,with satisfactory short-term outcomes.

关 键 词：肝胆管结石病 胆道手术史 胆道镜 经皮经肝胆管穿刺引流术 

分 类 号：R65[医药卫生—外科学]