经皮经肝胆道镜治疗复发性胆管结石的临床应用价值  

Clinical value of percutaneous transhepatic choledochoscopy in the treatment of recurrent calculus of bile duct

作　　者：高骥 白剑峰 夏金国 宋进华 石毅 GAO Ji;BAI Jian-feng;XIA Jin-guo(Department of Hepatobiliary Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院肝胆中心,江苏南京210029

出　　处：《腹腔镜外科杂志》2023年第2期118-122,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经皮经肝胆道镜(PTCS)治疗复发性胆管结石的操作技巧及临床价值。方法:回顾分析2019年6月至2022年6月收治的95例复发性胆管结石患者的临床资料,其中45例行PTCS,50例行腹腔镜胆总管探查(LCBDE)T管引流术,对比分析两组围手术期相关指标。结果:95例患者均因胆道结石行多次胆道手术,包括胆肠侧侧吻合、胆总管探查术、胆肠端侧吻合、肝部分切除术。PTCS组中40例行单通道PTCS,5例行双通道PTCS。患者均进行取石,其中32例联合双频激光碎石治疗。PTCS组取石治疗次数1~5次,平均(2.69±1.16)次;取石时间25~60 min,平均(40.33±10.90)min。随访2~29个月,16例患者出现发热、腹胀等胆管炎表现,4例胆管内见大量肠内容物反流。PTCS组取石时间短于LCBDE组,取石次数少于LCBDE组。结论:对于复发性胆管结石,相较常规LCBDE,PTCS可有效减轻手术创伤与风险,提高取石效率,是安全、有效的微创治疗方法。Objective:To explore the operative skills and clinical value of percutaneous transhepatic choledochoscopy(PTCS)in the treatment of recurrent calculus of bile duct.Methods:The clinical data of 95 patients with recurrent bile duct calculus from Jun.2019 to Jun.2022 were retrospectively analyzed,including 45 cases treated with PTCS and 50 cases treated with laparoscopic common bile duct exploration(LCBDE).Relevant indexes in perioperative period were compared and analyzed.Results:All cases had undergone multiple biliary operations for biliary stones,including side-to-side cholangioenterostomy,common bile duct exploration,end-to-side cholangioenterostomy,and partial hepatectomy.In the PTCS group,40 cases underwent single channel PTCS and 5 cases had double channels PTCS.All patients were treated with lithotripsy,of which 32 cases were treated with dual frequency laser lithotripsy.In the PTCS group,lithotripsy was performed 1-5 times,with the average of(2.69±1.16)times;the average operation time was 25-60 min,the average was(40.33±10.90)min.During the follow-up of 2-29 months,16 patients had cholangitis such as fever and abdominal distension,and 4 patients had a large amount of intestinal content reflux in the bile duct.Compared with the LCBDE group,the PTCS group has shorter stone extraction time and less times of calculi removal.Conclusions:Compared with LCBDE,PTCS can effectively reduce the surgical trauma and risk,and improve the stone removal efficiency.It is a safe,effective and minimally invasive treatment method for patients with recurrent bile duct stones.

关 键 词：胆管结石 腹腔镜检查 胆道镜检查 经皮经肝 胆总管探查 

分 类 号：R657.4[医药卫生—外科学]