超声引导行纤维胆道镜取石术治疗肝内外胆管结石临床观察  

Effect of ultrasound-guided fiber choledochoscopy in the treatment of patients with intrahepatic and extrahepatic bile duct stones

作　　者：郝晓慧 杨志军 冯薇 HAO Xiaohui;YANG Zhijun;FENG Wei(Department of Ultrasound,Hebi Aimin Hospital,Hebi 458030,China;Department of Ultrasound,Hebi People's Hospital,Hebi 458030,China)

机构地区：[1]鹤壁爱民医院超声科,河南鹤壁458030 [2]鹤壁市人民医院超声科,河南鹤壁458030

出　　处：《社区医学杂志》2023年第12期632-636,共5页Journal Of Community Medicine

摘　　要：目的探讨经超声引导行纤维胆道镜取石术治疗肝内外胆管结石的临床效果,旨在寻求更加有效的治疗方式。方法选取2017-03-01-2018-03-31鹤壁爱民医院收治的53例肝内外胆管结石患者为对照组,采用纤维胆道镜取石术治疗;同时选取同院2018-04-01-2019-04-30收治的53例肝内外胆管结石患者为观察组,采用超声引导行纤维胆道镜取石术治疗。观察2组治疗效果、炎症水平、残石率与复发率、术后并发症。结果术后,观察组治疗优良率为94.34%,高于对照组的79.25%,χ^(2)=5.267,P=0.022;观察组TNF-α水平为(14.90±2.36)ng/L、IL-6水平为(10.09±2.21)ng/L、CRP水平为(20.15±2.86)mg/L、IL-10水平水平为(13.48±3.25)ng/L,均低于对照组的(16.22±2.28)ng/L、(11.80±2.63)ng/L、(22.03±3.05)mg/L、(15.21±3.10)ng/L,F值分别为21.150、10.366、11.265、4.796,P值分别为<0.001、0.001、<0.001、0.029。观察组残石率为3.73%,低于对照组的15.09%,χ^(2)=3.975,P=0.046;残石复发率为8.89%,低于对照组的27.08%,χ^(2)=5.147,P=0.023;出现胆漏、切口感染及肠粘连并发症发生率为11.32%,低于对照组的28.30%,χ^(2)=4.810,P=0.028。结论经超声引导行纤维胆道镜取石术治疗肝内外胆管结石可有效减轻术后炎症水平,降低残石率、复发率及并发症发生率,提高治疗效果。Objective To investigate the effect of ultrasound-guided fibercholedochoscopy in the treatment of intrahepatic and extrahepatic bile duct calculi with the aim of seeking more effective treatment methods.Methods Totally 53patients with intrahepatic and extrahepatic bile duct calculi in Hebi Aimin Hospital from March 1,2017to March 31,2018were included in the control group and treated with fibrocholedochoscopy;meanwhile,53patients with intrahepatic and extrahepatic bile duct calculi in our hospital from April 1,2018to April 30,2019were included in the observation group and treated with ultrasound-guided fibrocholedochoscopy.The treatment effect,inflammatory level,residual stone rate,recurrence rate and postoperative complications were observed in the two groups.Results After surgery,the excellent and good treatment rate in the observation group was 94.34%,which was higher than 79.25%in the control group(χ^(2)=5.267,P=0.022);The tumor necrosis factor-α(TNF-α)levels(14.90±2.36)ng/L,interleukin-6(IL-6)levels(10.09±2.21)ng/L,C-reactive protein(CRP)levels(20.15±2.86)mg/L,and IL-10levels(13.48±3.25)ng/L in the observation group were lower than those of the control group(16.22±2.28)ng/L,(11.80±2.63)ng/L,(22.03±3.05)mg/L,and(15.21±3.10)ng/L,with Fvalues of 21.150,10.366,11.265,and 4.796,and Pvalues of<0.001,0.001,<0.001,and 0.029,respectively.The residual stone rate in the observation group was 3.73%,lower than 15.09%in the control group,withχ^(2)=3.975and P=0.046;The recurrence rate of residual stones was 8.89%,lower than the control group's 27.08%,χ^(2)=5.147,P=0.023;The incidence of complications such as bile leakage,incision infection,and intestinal adhesions was 11.32%,lower than the control group's 28.30%(χ^(2)=4.810,P=0.028).Conclusion Ultrasound-guided fibercholedochoscopy for the treatment of intrahepatic and extrahepatic bile duct calculi can effectively reduce postoperative inflammation,stone residual rate,recurrence rate and complication rate,and improve the therapeutic effect.

关 键 词：肝内外胆管结石 超声 纤维胆道镜 结石残留 结石复发 

分 类 号：R657.4[医药卫生—外科学]