伍远维 李俊龙 黄耘 叶勇

【摘要】 目的：觀察经皮肝穿刺胆管造瘘胆道镜取石术在复发性肝内外胆管结石中的应用。方法：回顾性分析笔者所在医院（2014年6月-2018年6月）收治以复发性肝内外胆管结石为诊断的患者相关资料。根据治疗方案不同，选取经皮肝穿刺胆管造瘘胆道镜取石术治疗的40例设置为A组，开腹手术治疗的40例设置为B组，并对两组进行为期1年的随访。对照两组手术相关指标（手术时间、术中出血量、术后复苏时间）、术后恢复情况（术后首次下床、首次排气、首次排便时间）、术后并发症（切口感染、胆瘘、胆道出血）与胆道结石复发情况。结果：A组手术时间、术中出血量、术后复苏时间均明显优于B组，差异均有统计学意义（P<0.05）。A组术后首次下床、首次排气、首次排便时间均明显早于B组，差异均有统计学意义（P<0.05）。A组与B组并发症发生率分别为2.50%、17.50%，A组并发症发生率明显低于B组，差异有统计学意义（P<0.05）。A组与B组1年内复发率分别为2.50%、5.00%，差异无统计学意义（P>0.05）。结论：在复发性肝内外胆管结石患者的治疗中，与传统开腹手术相比，经皮肝穿刺胆管造瘘胆道镜取石术可明显缩短手术时间，减少术中出血，缩短术后首次下床、首次排气及排便时间，降低并发症发生率，且1年内胆道结石复发率无明显升高。

【关键词】 经皮肝穿刺胆管造瘘胆道镜取石术; 复发; 肝内外胆管结石

doi：10.14033/j.cnki.cfmr.2019.27.014 文献标识码 B 文章编号 1674-6805（2019）27-00-03

Application of Percutaneous Transhepatic Cholangioscopic Lithotomy in the Treatment of Recurrent Intrahepatic and Extrahepatic Bile Duct Stones/WU Yuanwei，LI Junlong，HUANG Yun，et al.//Chinese and Foreign Medical Research，2019，17（27）：31-33

【Abstract】 Objective：To observe the application of percutaneous transhepatic cholangioscopic lithotomy in the treatment of recurrent intrahepatic and extrahepatic bile duct stones.Method：A total of 80 patients with recurrent intrahepatic and extrahepatic bile duct stones treated in our hospital from June 2014 to June 2018 were retrospectively analyzed.According to different treatment regimen，40 cases treated with percutaneous transhepatic cholangioscopic lithotomy were selected as the group A，another 40 cases treated with traditional surgery were selected as the group B，and two groups were followed up for one year.The operation-related indexes（operation time，intraoperative blood loss，postoperative resuscitation time），postoperative recovery（first time out of bed，first time of exhaust，first time of defecation），postoperative complications（wound infection，biliary fistula and hemobilia） and recurrence of biliary calculi were compared between the two groups.Result：The operation time，intraoperative blood loss and postoperative resuscitation time in the group A were significantly better than those of the group B，the differences were statistically significant（P<0.05）.The first time of out of bed，first time of exhaust，first time of defecation in the group A were significantly earlyer than those of the group B，the differences were statistically significant（P<0.05）.The incidence of complications in the group A and the group B were 2.50% and 17.50%，respectively，the incidence of complication in the group A was significantly lower than that of the group B，and the difference was statistically significant（P<0.05）.The recurrence rates of the group A and the group B within 1 year were 2.50% and 5.00%，respectively，and the difference was not statistically significant（P>0.05）.Conclusion：In the treatment of patients with recurrent intrahepatic and extrahepatic bile duct stones，compared with the traditional open surgery，percutaneous transhepatic cholangioscopic lithotomy can significantly shorten the operation time，decrease intraoperative blood loss，shorten the first time out of bed，first time of exhaust and first time of defecation，and reduce the incidence of complications and biliary calculi recurrence within 1 year and no obvious rise.

【Key words】 Percutaneous transhepatic cholangioscopic lithotomy; Recurrence; Intrahepatic and extrahepatic bile duct stones

First-authors address：Jiangmen Central Hospital，Jiangmen 529000，China

胆道结石是胆道系统中常见的疾病，手术治疗为主要治疗方法，但术后容易复发。临床中不少病例为复发性肝内外胆管结石患者，治疗多采用开腹手术，但存在创伤大，恢复慢，近期并发症多等问题[1]。经皮肝穿刺胆管造瘘胆道镜取石术（percutaneous transhepatic cholangioscopic lithotomy，PTCSL）在肝内外胆管结石治疗中获得较好的效果[2-4]。本研究回顾PTCSL和开腹手术治疗复发性肝内外胆管结石患者的资料，进行统计分析，报道如下。……