摘要
目的探讨经皮经肝胆道镜(PTCS)取石术在胆总管结石合并急性胆管炎治疗中的安全性和疗效。方法回顾性分析2012年11月至2017年11月在湛江中心人民医院行PTCD后择期行手术治疗的95例胆总管结石合并急性胆管炎患者临床资料。其中男44例,女51例;平均年龄(55±9)岁。患者均签署知情同意书,符合医学伦理学规定。患者均急诊行PTCD,感染控制后二期手术治疗。根据手术方式不同将患者分为PTCS组(43例)和腹腔镜胆总管探查取石术组(LCBDE组,52例)。PTCS组行腹腔镜胆囊切除术(LC)+PTCS取石术,LCBDE组行LC+LCBDE+T管引流术。两组手术时间、术后胆道引流管拔除时间比较采用t检验,并发症发生率比较采用χ^2检验。结果患者均顺利完成手术,无术中中转开腹。PTCS组手术时间和术后胆道引流管拔除时间分别为(90±16)min、(8.0±1.4)d,明显少于LCBDE组的(184±18)min、(31.3±1.8)d(t=-26.620,-70.555;P<0.05)。两组无发生围手术期死亡及严重并发症。PTCS组胆道出血2例,右侧胸腔积液1例,LCBDE组胆漏3例,两组并发症发生率差异无统计学意义(χ^2=0.058,P>0.05)。两组结石清除率均为100%。随访时间12~36个月,中位时间26个月,随访期间均未发现结石复发及胆管炎复发。结论PTCS具有安全、有效、创伤小、术后恢复快的优点,可作为胆总管结石合并急性胆管炎PTCD后的一种手术方式。
Objective To evaluate the safety and efficacy of percutaneous transhepatic cholangioscopy(PTCS)in the treatment of choledocholithiasis complicated with acute cholangitis.Methods Clinical data of 95 patients with choledocholithiasis complicated with acute cholangitis undergoing selective operation after PTCD in Central People's Hospital of Zhanjiang from November 2012 to November 2017 were retrospectively analyzed.Among them,44 patients were male and 51 female,aged(55±9)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients underwent emergent PTCD and received secondary operation after infection control.Patients were divided into the PTCS group(n=43)and laparoscopic common bile duct exploration group(LCBDE group,n=52)according to different surgical methods.In the PTCS group,patients received laparoscopic cholecystectomy(LC)+PTCS lithotomy,whereas those in the LCBDE group received LC+LCBDE+T-tube drainage.The operation time and postoperative removal time of biliary drainage tube were statistically compared between two groups by t test.The incidence of postoperative complications was compared by Chi-square test.Results All patients completed the operation successfully without conversion to open surgery.In the PTCS group,the operation time and postoperative removal time of biliary drainage tube were(90±16)min and(8.0±1.4)d,significantly shorter than(184±18)min,(31.3±1.8)d in the LCBDE group(t=-26.620,-70.555;P<0.05).No perioperative death or serious complications occurred in two groups.In the PTCS group,2 cases suffered from biliary hemorrhage and 1 case of right pleural effusion.In the LCBDE group,3 cases suffered from biliary leakage.No significant difference was observed in the incidence of postoperative complications between two groups(χ^2=0.058,P>0.05).The stone removal rate was 100%in both groups.The follow-up time was 12-36 months with a median of 26.No recurrence of stones or cholangitis was found during the postoperative follow-up.Conclusions PTCS is a safe and efficacious surgical treatment for choledocholithiasis complicated with acute cholangitis,which causes mild trauma and accelerates postoperative recovery.
作者
罗晓峰
黄子榕
王振龙
何涛
彭观景
李康德
陈博艺
李荣
李称才
Luo Xiaofeng;Huang Zirong;Wang Zhenlong;He Tao;Peng Guanjing;Li Kangde;Chen Boyi;Li Rong;Li Chengcai(Department of Hepatobiliary Surgery,Central People's Hospital of Zhanjiang,Zhanjiang 524000,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2019年第5期448-452,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
广东省湛江市非资助科技攻关计划项目(2018B01144)
关键词
胆总管结石
胆管炎
胆道镜
引流术
Choledocholithiasis
Cholangitis
Cholangioscopy
Drainage
