经皮肝穿刺胆道镜取石术治疗肝内外胆道结石的疗效及安全性观察

摘要

Objective:To investigate the efficacy and safety of percutaneous transhepatic choledochosco-py in the treatment of intrahepatic and extrahepatic bile duct stones. Method:The clinical data of 92 patients with intrahepatic and extrahepatic biliary calculi in our hospital were retrospectively analyzed.Among them,32 cases underwent percutaneous transhepatic choledochoscopy(observation group),60 cases underwent conven-tional common bile duct lithotomy and T tube drainage(control group). The clinical efficacy(stone clearance rate,postoperative stone recurrence rate),operative related indexes(operation time,intraoperative bleeding, incision length,postoperative exhaust time,fasting time,hospitalization time),postoperative rehabilitation in-dexes [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (STB)], liver function indexes and postoperative complications were compared between the two groups. Results: There was no significant difference in stone removal rate and postoperative stone recurrence rate between the two groups (P >0.05). The operation time,intraoperative bleeding,incision length,postoperative exhaust time and fast-ing time in the observation group were significantly lower than those in the control group(P<0.05). The post-operative ALT,AST and STB of the two groups were significantly lower than those before operation (P<0. 05),but there was no significant difference between the two groups in liver function index(P>0.05). The in-cidence of complications in the observation group was lower than that in the control group,the difference was statistically significant (P<0.05). Conclusion: Percutaneous transhepatic choledochoscopy and traditional surgery are effective in the treatment of intrahepatic and extrahepatic bile duct stones,and can improve the liv-er function of patients. But the former has the advantages of minimally invasive,less trauma,rapid postopera-tive recovery,low incidence of complications,and has more clinical value.%目的:探讨经皮肝穿刺胆道镜取石术治疗肝内外胆道结石的疗效及安全性.方法:回顾性分析92例肝内外胆道结石患者的临床资料,其中行经皮肝穿刺胆道镜取石术(观察组)32例,行传统胆总管切开取石术+T管引流术(对照组)60例.对比两组临床疗效(结石取尽率、术后结石复发率)、手术相关指标及术后康复指标(手术时间、术中出血、切口长度、术后排气时间、禁食时间、住院时间)、肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(STB)及术后并发症发生率.结果:两组结石取尽率、术后结石复发率比较无显著差异(P>0.05).观察组手术时间、术中出血、切口长度、术后排气时间、禁食时间均显著低于对照组(P<0.05).两组术后ALT、AST、STB 均较术前显著降低(P<0.05),但组间各肝功能指标比较无显著差异(P>0.05).观察组并发症发生率低于对照组,差异有统计学意义(P<0.05).结论:经皮肝穿刺胆道镜取石术与传统手术治疗肝内外胆道结石疗效相当,且均可改善患者肝功能,但前者具有微创优势,创伤小,术后恢复快,并发症发生率低,更具临床应用价值.