经皮经肝穿刺一期硬质胆道镜取石术治疗肝内胆管结石的疗效分析  

Curative effect of percutaneous transhepatic primary rigid choledochoscopy in the treatment of intrahepatic bile duct stones

作　　者：姚红兵 罗旭 吴嘉兴 蒋建晖 赵东康 陆才进 王泽文 孔娟 徐军红 YAO Hong-bing;LUO Xu;WU Jia-xing;JIANG Jian-hui;ZHAO Dong-kang;LU Cai-jin;WANG Ze-wen;KONG Juan;XU Jun-hong(Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Guilin Medical University,Guilin Guangxi 541199,China;Department of Radiological Intervention,Second Affiliated Hospital of Guilin Medical University,Guilin Guangxi 541199,China)

机构地区：[1]桂林医学院第二附属医院肝胆胰外科,广西桂林541199 [2]桂林医学院第二附属医院放射介入科,广西桂林541199

出　　处：《局解手术学杂志》2022年第11期984-988,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：桂林市科技计划项目(2020011205-2);广西医疗卫生重点培育学科建设项目。

摘　　要：目的探讨经皮经肝穿刺一期硬质胆道镜取石术治疗肝内胆管结石的疗效及对患者术后疼痛、炎症因子、术后并发症及复发的影响。方法选取我院接受开腹手术治疗的60例肝内胆管结石患者(对照组)与接受经皮经肝穿刺一期硬质胆道镜取石术的60例肝内胆管结石患者(观察组)作为研究对象。比较2组患者的总有效率、一次性结石清除率、手术情况、术后视觉模拟量表(VAS)评分、术后炎症因子指标、术后并发症发生率、术后恢复时间、住院时间、术后复发率。结果2组患者的总有效率、一次性结石清除率、术后6个月复发率比较差异均无统计学意义(P>0.05)。2组患者的手术时间比较差异无统计学意义(P>0.05)。观察组的术中出血量少于对照组(P<0.05),术后首次排气时间、术后下床活动时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。观察组术后1~3 d的VAS评分、C反应蛋白和白细胞介素-6均低于对照组,差异有统计学意义(P<0.05)。观察组的术后并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论经皮经肝穿刺一期硬质胆道镜取石术不仅可提高肝内胆管结石患者的结石清除效果,降低术后远期复发风险,还可减轻手术创伤,减少术后并发症的发生,加快术后康复。Objective To investigate the efficacy of percutaneous transhepatic primary rigid choledochoscopy in the treatment of intrahepatic bile duct stones and its effects on postoperative pain,inflammatory factors,postoperative complications and recurrence.Methods A total of 60 patients with intrahepatic bile duct stones treated by laparotomy(the control group)and 60 patients with intrahepatic bile duct stones treated by percutaneous transhepatic primary rigid choledochoscopy(the observation group)were selected as research objects.The total effective rate,one-time stone removal rate,operation condition,postoperative visual analogue scale(VAS)score,postoperative inflammatory factor indexes,postoperative complication rate,postoperative recovery time,hospitalization time and postoperative recurrence rate of the two groups were compared.Results There was no statistically significant difference in the total effective rate,one-time stone removal rate and recurrence rate 6 months after operation between the two groups(P>0.05).There was no statistically significant difference in the operation time between the two groups(P>0.05).The amount of intraoperative bleeding in the observation group was less than that in the control group(P<0.05),the first postoperative exhaust time,time of getting out of bed after operation and hospitalization time in the observation group were shorter than those in the control group,and the differences were statistically significant(P<0.05).The VAS scores,C-reactive protein and interleukin-6 in the observation group 1 to 3 days after operation were lower than those in the control group,and the differences were statistically significant(P<0.05).The postoperative complication rate in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion Percutaneous transhepatic primary rigid choledochoscopy can not only improve the stone removal effect of patients with intrahepatic bile duct stones,reduce the risk of long-term recurrence after o

关 键 词：肝内胆管结石 经皮经肝穿刺一期硬质胆道镜取石术 微创手术 开腹手术 术后并发症 

分 类 号：R575.6[医药卫生—消化系统]