分步法微创治疗失代偿期肝硬化合并胆总管结石患者的疗效分析  

Step-by-step mini-invasive treatment for choledocholithiasis patients with decompensated liver cirrhosis

作　　者：邬杰忠 张鹏[1] 熊志勇[1] 黄河[1] 胡昆鹏[1] 刘波[1] Wu Jiezhong;Zhang Peng;Xiong Zhiyong;Huang He;Hu Kunpeng;Liu Bo(Department of General Surgery,Lingnan Hospital,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院岭南医院普通外科,广州510530

出　　处：《国际医药卫生导报》2021年第21期3281-3284,共4页International Medicine and Health Guidance News

基　　金：国家自然科学基金项目(81572726);广东省自然科学基金项目(2018A030313641)。

摘　　要：目的探讨分步法微创治疗失代偿期肝硬化合并胆总管结石患者的疗效。方法回顾性分析2017年1月至2020年12月中山大学附属第三医院岭南医院收治的16例失代偿期肝硬化合并胆总管结石患者的临床资料。其中男12例,女4例;年龄(47.7±10.2)岁;乙肝肝硬化14例,丙肝肝硬化1例,酒精性肝硬化1例;肝功能Child-PughB级5例,Child-PughC级11例。围术期先行经皮经肝胆囊穿刺置管引流(PTGD),待患者症状好转、炎症消退后,序贯术中内镜逆行胰胆管造影术(ERCP)联合腹腔镜胆囊切除术。观察手术情况及术后并发症发生情况。结果患者均顺利完成PTGD,14例(87.5%)顺利完成ERCP,其中十二指肠乳头括约肌切开术(EST)取石10例(62.5%)、十二指肠乳头球囊扩张术(EPBD)取石4例(25.0%),2例(12.5%)未能成功取石;14例(87.5%)患者顺利完成腹腔镜胆囊切除术,2例(12.5%)中转开腹。术中出血量(347.9±85.5)ml,住院时间(35.1±2.7)d,EST术后十二指肠乳头出血3例(18.8%),急性胰腺炎3例(18.8%),消化道出血1例(6.3%),术后腹水恶化2例(12.5%),切口感染2例(12.5%),腹泻6例(37.5%),肺部感染1例(6.3%),死亡1例(6.3%),无术后胆漏并发症。结论对失代偿期肝硬化合并胆总管结石患者,围术期PTGD序贯术中ERCP联合腹腔镜胆囊切除可有效降低手术风险,并发症率和病死率较低,是一种安全、有效的方法。Objective To explore the clinical efficacy of step-by-step mini-invasive treatment for choledocholithiasis patients with decompensated liver cirrhosis.Methos The clinical data of 16 patients with cholelithiasis and decompensated liver cirrhosis treated at Lingnan Hospital,The Third Affiliated Hospital of Sun Yat-sen University from January 2017 to December 2020 were retrospectively analyzed.Among them,there were 12 males and 4 females,with an age of(47.7±10.2).Fourteen patients had HBV-related cirrhosis,1 HCV-related cirrhosis,and 1 alcohol hepatic cirrhosis.Five patients got Child-Pugh classification B,and 11 Child-Pugh classification C.All the patients took percutaneous transhepatic gallbladder drainage(PTGD)during perioperative period.When the patients'symptoms and inflammation recovered after PTGD,the patients were sequentially treated by intraoperative endoscopic retrograde cholangiopancreatography(ERCP)and laparoscopic cholecystectomy.The operative conditions and postoperative complications were observed.Results All the patients underwent PTGD successfully.Fourteen patients(87.5%)took ERCP successfully.Ten cases(62.5%)were removed the stones by endoscopic sphincterotomy(EST),and 4(25.0%)by endoscopic papillary balloon dilation(EPBD);and 2 cases'stones were not successfully removed.Fourteen patients(87.5%)underwent laparoscopic cholecystectomy successfully,2 cases(12.5%)were converted to an open procedure.The intra-operative bleeding volume was(347.9±85.5)ml.The hospitalization time was(35.1±2.7)days.Three cases(18.8%)bled on their duodenal papillae after EST.Three cases(18.8%)had acute pancreatitis,one case(6.25%)gastrointestinal bleeding,two cases(12.5%)worsened ascites,two cases(12.5%)incision infection,six cases(17.2%)postoperative diarrhea,and one case(6.25%)pulmonary inflammation.One patient(6.25%)died.None of the patients developed bile leakage.Conclusion Perioperative PTGD and intraoperative ERCP combined with laparoscopic cholecystectomy can reduce the surgical risk for choledocholithiasis patien

关 键 词：肝硬化 胆总管结石 ERCP 胆囊穿刺置管引流 腹腔镜 胆囊切除术 

分 类 号：R575.2[医药卫生—消化系统] R657.4[医药卫生—内科学]