硬质胆道镜治疗肝胆管结石的临床研究(1)
【摘要】 目的：探討硬质胆道镜治疗肝胆管结石的临床疗效及应用价值。方法：回顾性分析2016年8月-2019年5月本院采用硬质胆道镜手术治疗120例肝胆管结石患者的临床资料，其中胆总管切开取石术80例(包括传统开腹组40例和腹腔镜组40例)，经皮肝胆道造瘘硬质胆道镜取石术组(percutaneous transhepatic cholangioscopy，PTCS)40例，比较不同术式结石清除时间、结石清除率及并发症等指标。结果：胆总管切开取石术传统开腹组和腹腔镜组在术中出血量、术后住院时间和结石清除率方面比较，差异均有统计学意义(P<0.05)，其中传统开腹组术中出血量明显比腹腔镜组多，术后住院时间较腹腔镜组长，结石清除率较腹腔镜组低;而手术时间及并发症发生率比较，差异均无统计学意义(P>0.05)。两组术后经T管瘘道取石共23例，经T管瘘道取石组与PTCS组在手术时间、术中出血量、术后住院时间、结石清除率及并发症发生率方面比较，差异均无统计学意义(P>0.05)。结论：传统开腹手术比较适合治疗复杂性肝胆管结石，结石清除率较腹腔镜手术组低，与传统开腹手术组结石分布相对比较复杂有关，腹腔镜手术虽创伤少，但操作难度较大，耗时较长。另外，硬质胆道镜可经PTCD瘘道和T管瘘道进入肝内多数胆管或胆总管进行取石，两者疗效无明显差异，值得推广用于结石嵌顿或铸型、胆管狭窄等纤维胆道镜无法处理的较复杂肝胆管结石治疗，对于多次手术或肝功受限或肝内梗阻性重症胆管炎患者比较适合PTCS治疗。
【关键词】 胆道镜 腹腔镜 PTCS 肝胆管结石
[Abstract] Objective： To investigate the clinical efficacy and application value of rigid choledochoscopy in the treatment of hepatolithiasis. Method： The clinical data of 120 patients with hepatolithiasis treated by rigid choledochoscopy in the Central People’s Hospital of Zhanjiang City from August 2016 to May 2019 were retrospectively analyzed. A total of 80 patients underwent choledochotomy (including 40 cases in the traditional open group and 40 cases in the laparoscopic group) and 40 patients underwent percutaneous transhepatic cholangiostomy (PTCS) with rigid choledochoscopy. Calculus clearance time， stone clearance rate and complications of patients were measured. Result： There were significant differences in bleeding volume， hospital stay and stone removal rate between the traditional open group and laparoscopic group (P<0.05). The amount of intraoperative blood loss in the traditional laparotomy group was significantly higher than that in the laparoscopic group， the length of postoperative hospital stay was longer than that in the laparoscopic group， and the calculi clearance rate was lower than that in the laparoscopic group. However， there were no statistical differences in the operative time and the incidence of complications (P>0.05). A total of 23 cases were removed by T-tube fistula after operation in the two groups. There were no significant differences in operation time， intraoperative blood loss， postoperative hospital stay， calculus clearance rate and complication rate between the T-tube fistula extraction group and the PTCS group (P>0.05).Conclusion： Traditional open abdominal surgery is more suitable for the treatment of complicated hepatic bile duct stones. The clearance rate of stones in the traditional open abdominal group is lower than that of laparoscopic surgery group. The reason is that the distribution of stones in traditional open abdominal surgery is relatively complex. Although laparoscopic surgery is less traumatic， it is more difficult to operate and takes longer. In addition， rigid choledochoscope can be used to remove stones through PTCD fistula and T-duct fistula into most bile ducts or bile ducts in the liver. There is no significant difference in the efficacy of the two groups. So we can use the method in the treatment of complex bile duct stones that can not be treated by the fibrous bile duct mirrors such as stone incarceration or casting， bile duct stricture and so on. It is more suitable to be treated for the patients with multiple biliary surgery， hepatic injury， severe intrahepatic obstructive cholangitis by PTCS., http://www.100md.com(彭观景 陈博艺 李称才 何涛 李荣)
【关键词】 胆道镜 腹腔镜 PTCS 肝胆管结石
[Abstract] Objective： To investigate the clinical efficacy and application value of rigid choledochoscopy in the treatment of hepatolithiasis. Method： The clinical data of 120 patients with hepatolithiasis treated by rigid choledochoscopy in the Central People’s Hospital of Zhanjiang City from August 2016 to May 2019 were retrospectively analyzed. A total of 80 patients underwent choledochotomy (including 40 cases in the traditional open group and 40 cases in the laparoscopic group) and 40 patients underwent percutaneous transhepatic cholangiostomy (PTCS) with rigid choledochoscopy. Calculus clearance time， stone clearance rate and complications of patients were measured. Result： There were significant differences in bleeding volume， hospital stay and stone removal rate between the traditional open group and laparoscopic group (P<0.05). The amount of intraoperative blood loss in the traditional laparotomy group was significantly higher than that in the laparoscopic group， the length of postoperative hospital stay was longer than that in the laparoscopic group， and the calculi clearance rate was lower than that in the laparoscopic group. However， there were no statistical differences in the operative time and the incidence of complications (P>0.05). A total of 23 cases were removed by T-tube fistula after operation in the two groups. There were no significant differences in operation time， intraoperative blood loss， postoperative hospital stay， calculus clearance rate and complication rate between the T-tube fistula extraction group and the PTCS group (P>0.05).Conclusion： Traditional open abdominal surgery is more suitable for the treatment of complicated hepatic bile duct stones. The clearance rate of stones in the traditional open abdominal group is lower than that of laparoscopic surgery group. The reason is that the distribution of stones in traditional open abdominal surgery is relatively complex. Although laparoscopic surgery is less traumatic， it is more difficult to operate and takes longer. In addition， rigid choledochoscope can be used to remove stones through PTCD fistula and T-duct fistula into most bile ducts or bile ducts in the liver. There is no significant difference in the efficacy of the two groups. So we can use the method in the treatment of complex bile duct stones that can not be treated by the fibrous bile duct mirrors such as stone incarceration or casting， bile duct stricture and so on. It is more suitable to be treated for the patients with multiple biliary surgery， hepatic injury， severe intrahepatic obstructive cholangitis by PTCS., http://www.100md.com(彭观景 陈博艺 李称才 何涛 李荣)