中国普外基础与临床杂志

中国普外基础与临床杂志

超声引导经皮经肝穿刺一期窦道扩张引流+二期胆道镜多次取石治疗复杂肝内胆管结石(附 42 例报道)

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目的 探讨超声引导经皮经肝穿刺一期窦道扩张引流+二期胆道镜多次取石治疗复杂肝内胆管结石的可行性及疗效。 方法 收集 2012 年 6 月至 2017 年 6 月期间西安交通大学第一附属医院肝胆外科胆道病区采用超声引导经皮经肝胆道镜检查术治疗的 42 例复杂肝内胆管结石患者,治疗均采用超声引导经皮经肝穿刺一期窦道扩张引流+二期胆道镜多次碎石取石术。 结果 42 例患者手术均成功,无中转手术。穿刺右侧肝内胆管 10 例、左侧肝内胆管 25 例及双侧肝内胆管 7 例。31 例患者通过二期胆道镜探查取净结石,其中 1 次取净结石者 4 例、2 次取净结石者 6 例、3 次及以上取净结石者 21 例;11 例有结石残留。一期窦道扩张引流后出现胆管出血 4 例、胆管炎 8 例及胸部并发症 2 例,术后引流管脱落 2 例。二期胆道镜取石后出现胆管炎 3 例,引流管脱落 3 例。术后随访(18.6±7.8)个月,31 例取净结石患者中 10(32.2%)例结石复发;11 例结石残留患者中 9 例获得随访,病情基本稳定。 结论 超声引导下经皮经肝穿刺一期窦道扩张引流+二期胆道镜多次取石治疗复杂肝内胆管结石安全、有效,可对传统手术有效补充。

Objective To investigate feasibility and curative effect of ultrasound-guided percutaneous transhepatic cholangioscopy (PTCS) in treatment of complicated hepatolithiasis, including the first stage of dilation and drainage and the second stage choledochoscopy. Methods From June 2012 to June 2017, 42 patients with complicated hepatolithiasis in Hepatobiliary Surgery, the First Affiliated Hospital of Xi’an Jiaotong University. All the patients were treated with ultrasound-guided PTCS. Results The operations of the 42 patients were successfully performed. No cases was converted to the conventional laparotomy. The puncture sites of 10 cases were at the right intrahepatic bile duct, 25 cases were at the left intrahepatic bile duct, 7 cases were at the bilateral intrahepatic bile duct. The residual stones were removed by two stage choledochoscopy in the 31 (73.8%) patients, 11 (26.2%) patients had the residual stones. In the first stage, there were 4 cases of the bile duct hemorrhage, 8 cases of the cholangitis, 1 case of pleural effusion and 1 case of infection), 2 cases of the postoperative drainage tube shedding. In the second stage, there were 3 cases of the cholangitis and 3 cases of the postoperative drainage tube shedding. The stones of the 10/31 patients with stone removal occurred and the disease of 9/11 patients with stone residual were stable during following-up of (18.6±7.8) months. Conclusion Ultrasound-guided PTCS including the first stage of dilation and drainage plus the second stage choledochoscopy is safe and effective in treatment of complex intrahepatic bile duct stones, it is an effective supplement to traditional surgery.

关键词: 肝内胆管结石; 经皮经肝胆道镜检查术; 碎石术

Key words: hepatolithiasis; percutaneous transhepatic cholangioscopy; lithotomy

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