摘要：
目的 探讨硬质胆道镜经瘘道治疗胆管结石的适应证、可行性及疗效.方法 回顾性分析2014年11月至2016年7月我院86例采用硬质胆道镜经瘘道治疗胆管结石患者的临床资料,按不同治疗方式分两组.经皮肝穿刺胆道引流(PTCD)瘘道组:40例PTCD和瘘道扩张后,经PTCD瘘道硬质胆道镜取石治疗;T管瘘道组:46例经胆总管切开取石术后胆管残石,至少4周后经T管瘘道硬质胆道镜取石治疗.比较两组患者的手术时间、术中出血量、手术并发症发生率及结石残留率等.结果 PTCD瘘道组平均手术时间(77.0±36.5) min,术中出血量(26.5 ±54.1)ml,手术并发症发生率37.5％ (15/40),Ⅰ期完全取净结石者33例,Ⅱ期取净者l例,结石残留率15.0％ (6/40).T管瘘道组平均手术时间(82.5 ±44.1)min,术中出血量(14.8 ±21.0) ml,手术并发症发生率32.6％(15/46),Ⅰ期完全取净结石者34例,Ⅱ期取净者2例,结石残留率21.7％ (10/46).两组患者的结石残留率、并发症发生率及手术时间差异均无统计学意义(P＞0.05).T管瘘道组患者出血量明显低于PTCD瘘道组,差异具有统计学意义(P＜0.05).结论 硬质胆道镜可经PTCD瘘道或T管瘘道进入肝内多数胆管或胆总管取石,两者疗效无明显差异,值得推广用于肝内、外嵌顿性结石或铸型结石的治疗.%Objective To study the indications,feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones.Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016.Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group.There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract.A comparison was conducted to compare the duration of the procedures,the amount of perioperative bleeding,the postoperative complication rates and residual stone rates between the two groups.Results In the PTCD group,the average operation time was (77.0 ± 36.5) min,the amount of perioperative bleeding was (26.5 ± 54.1) ml,and the postoperative complication rate was 37.5 ％ (15/40).Complete lithotomy in one-stage was successful in 33 patients,and in two-stages in 1 patient.The residual stone rate was 15.0％ (6/40).In the T tube tract group,the average operation time was (82.5 ± 44.1) min,the amount of perioperative bleeding was (14.8 ± 21.0) ml,and the postoperative complication rate was 32.6％ (15/46).Complete lithotomy in one-stage was successful in 34 patients,and two-stages in 2 patients.The residual stone rate was 21.7％ (10/46).There were no significant differences in the residual stone rates,complication rates and operation time between the two groups (P ＞ 0.05).The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group,(P ＜ 0.05).Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group.Both approaches can be used for bile duct stones.
