经皮经肝胆道镜取石术治疗复发性胆总管结石的疗效分析  

Efficacy analysis of percutaneous transhepatic cholangioscopy in the treatment of recurrent choledocholithiasis

作　　者：陈奇 王瑞瑞 李良[2] 鲁俊[1,2] CHEN Qi;WANG Ruirui;LI Liang(Department of General Surgery,Affiliated Hefei Second People's Hospital,Bengbu Medical College,Hefei 230011,China;Department of General Surgery,Hefei Second People's Hospital)

机构地区：[1]蚌埠医科大学附属合肥市第二人民医院普通外科,安徽合肥230011 [2]合肥市第二人民医院普通外科

出　　处：《腹腔镜外科杂志》2024年第12期915-920,共6页Journal of Laparoscopic Surgery

基　　金：蚌埠医学院自然科学基金(2022byzd215)。

摘　　要：目的:探讨一步法与二步法改良经皮经肝胆道镜取石术治疗复发性胆总管结石的临床效果,总结两种术式的优缺点,以指导临床术式的选择。方法:回顾分析2022年6月至2024年6月采用经皮经肝胆道镜取石术治疗的79例复发性胆总管结石患者的临床资料,其中男38例,女41例;平均(67.2±10.5)岁;按照取石方法将41例采用一步造瘘法的患者设为A组,38例采用二步造瘘法的患者作为B组。比较两组临床资料及恢复情况。结果:A组术前总胆红素、谷丙转氨酶、谷草转氨酶数值更低,一次穿刺成功率高于B组,术中出血多于B组,手术时间、住院时间短于B组,术后进食恢复时间长于B组,住院费用、术后并发症少于B组,差异有统计学意义(P<0.05)。A组手术中转率为2.4%(1/41),B组为7.9%(3/38),中转患者均行腹腔镜联合胆道镜胆总管探查取石术。两组患者一般情况,术前实验室检查中除总胆红素、谷丙转氨酶、谷草转氨酶以外的结果,胆总管直径,结石数量与大小,术后实验室检查结果,结石取净率,胃肠道生活质量指数,中转率,疼痛评分,胆道引流量差异均无统计学意义(P>0.05)。结论:两种改良经皮经肝胆道镜取石术治疗复发性胆总管结石均是安全、有效的,与两步法相比,一步法的优势更加明显,值得临床推广。Objective:To investigate the clinical outcomes of one-step and two-step modified percutaneous transhepatic cholangioscopic lithotomy in the treatment of recurrent choledocholithiasis,and to summarize their respective advantages and disadvantages to guide clinical procedure selection.Methods:A retrospective analysis was conducted on clinical data of 79 patients who underwent percutaneous transhepatic cholangioscopic lithotomy for recurrent choledocholithiasis from Jun.2022 to Jun.2024.Among them,there were 38 male and 41 female patients,with a mean age of(67.2±10.5)years.Based on the different calculi retrieval methods,41 patients who u nderwent one-step fistulization were assigned to group A,and 38 patients who underwent two-step fistulization were assigned to group B.Clinical data and patient recovery were compared between the two groups.Results:Compared with group B,group A had lower preoperative total bilirubin,ALT and AST levels,higher success rate for single puncture,more intraoperative blood loss,shorter operation time and hospital stay,longer time to resume oral intake,lower hospitalization costs and fewer postoperative complications,with statistically significant differences(P<0.05).The intraoperative conversion rate was 2.4%(1/41)in group A and 7.9%(3/38)in group B,and all converted to combined laparoscopy-choledochoscopy common bile duct exploration and lithotomy.There were no statistically significant differences between the two groups in general conditions,preoperative laboratory results(excluding total bilirubin,ALT,AST),bile duct diameter,number and size of stones,postoperative laboratory results,calculi clearance rate,gastrointestinal quality of life index,conversion rate,pain score,and bile duct drainage volume(P>0.05).Conclusions:Both methods of modified percutaneous transhepatic cholangioscopic lithotomy are safe and effective for treating recurrent choledocholithiasis.Compared with the two-step method,the one-step method demonstroates more obvious advantages and is worth promoting in clinical

关 键 词：胆总管结石病 经皮经肝穿刺胆道镜取石术 胆道外科手术 胆道镜检查 腹腔镜检查 

分 类 号：R657.4[医药卫生—外科学]