人工控制性胆道加压注水在复杂肝胆管结石经皮经肝胆道镜取石术中的应用  

Application of maneuverable high-pressure water injection into bile duct during percutaneous transhepatic cholangioscopic lithotripsy for complicated hepatolithiasis

作　　者：李嘉[1] 李雄 Li Jia;Li Xiong(Department of Hepatobiliary Surgery,Meizhou People's Hospital,Meizhou 514031,China;Department of Ultrasound,Meizhou People's Hospital,Meizhou 514031,China)

机构地区：[1]广东省梅州市人民医院肝胆外科,514031 [2]广东省梅州市人民医院超声科,514031

出　　处：《中华肝脏外科手术学电子杂志》2023年第1期87-90,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广东省医学科研基金项目(B2021327)。

摘　　要：目的探讨人工控制性胆道加压注水在经皮经肝胆道镜取石术(PTCSL)治疗复杂肝胆管结石中的应用价值。方法回顾性分析2014年8月至2021年9月在梅州市人民医院诊治的11例复杂肝胆管结石患者临床资料。其中男6例,女5例;平均年龄(61±9)岁。胆总管结石合并左、右肝管结石3例,胆总管结石合并右肝管结石2例,胆总管结石合并左肝管结石1例,左、右肝管结石3例,右肝管结石1例,胆总管结石1例。患者均签署知情同意书,符合医学伦理学规定。患者行PTCD引出感染性胆汁1周后,建立人工控制性胆道加压注水,使肝内胆管扩张,采用PTCSL取石。观察患者胆道穿刺造瘘成功率、结石清除率、围手术期情况以及术后并发症发生情况。结果患者均顺利完成手术,PTCD胆道穿刺平均造瘘时间(15±3)min,穿刺造瘘成功率100%(11/11),手术时间(130±27)min,术中出血量(15±14)ml,总住院时间(22±13)d,术后无腹腔出血、胆漏等并发症发生,结石清除率91%(10/11)。结论对于复杂肝胆管结石患者,利用人工控制性胆道加压注水的方法建立经皮经肝取石通道是一种安全、可行的方法。Objective To evaluate the application value of maneuverable high-pressure water injection into the bile duct in percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)for complicated hepatolithiasis.Methods Clinical data of 11 patients with complicated hepatolithiasis admitted to Meizhou People's Hospital from August 2014 to September 2021 were retrospectively analyzed.Among them,6 patients were male and 5 female,aged(61±9)years on average.3 cases of choledocholithiasis were complicated with the left and right hepatic duct stones,2 cases of choledocholithiasis complicated with the right hepatic duct stones,1 case of choledocholithiasis complicated with the left hepatic duct stone,3 cases of the left and right hepatic duct stones,1 case of the right hepatic duct stone and 1 case of choledocholithiasis,respectively.The informed consents of all patients were obtained and the local ethical committee approval was received.After 1-week drainage of bile by percutaneous transhepatic cholangiodrainage(PTCD),maneuverable high-pressure water injection into the bile duct was performed to dilate the intrahepatic bile duct,and biliary stones were removed by PTCSL.The success rate of biliary tract puncture and fistulization,stone removal rate,perioperative conditions and postoperative complications were observed.Results All patients successfully completed the surgery.The average fistulization time during PTCD-guided bile duct puncture was(15±3)min,the success rate of puncture and fistulization was 100%(11/11),the operation time was(130±27)min,intraoperative blood loss was(15±14)ml,and the total length of hospital stay was(22±13)d.No abdominal hemorrhage or biliary leakage occurred after surgery.The stone clearance rate was 91%(10/11).Conclusions For patients with complicated hepatolithiasis,it is a safe and feasible approach to establisha PTCSL route by maneuverable high-pressure water injection into the bile duct.

关 键 词：胆结石 胆道镜 经皮经肝胆道镜取石 胆道加压注水 

分 类 号：R65[医药卫生—外科学]