关键词: 肝内胆管结石, 经皮经肝胆道镜取石术, 硬质胆道镜, 并发症, 复发

Abstract: Objective To investigate the efficacy of percutaneous transhepatic choledochoscopic lithotripsy （PTCL） in patients with intrahepatic cholelithiasis after two-year follow-up.Methods 200 patients with intrahepatic cholelithiasis were enrolled in our hospital between March 2013 and March 2015,and were randomly divided into two groups with 100 in each,receiving PTCL or conventional open laparotomy. The operation parameters,complications and relapse of stone after two-year follow-up in the two groups were compared.Results The body mass index （BMI） was （24.2±2.2） kg/m²,the diameter of stone was （4.3±0.5） mm,and the percentages of stone location in the left,right and both hepatic ducts in PTCL-treated group were 56.0%,37.0% and 7.0%,not significantly different as compared to （24.0±3.0） kg/m²,（4.4±0.6） mm,55.0%,39.0% and 6.0% （P>0.05） in patients receiving open laparotomy;the operation finished in both groups and the stones were cleared out;the operation time was （154.3±21.8） min,bleeding volume was （96.3±15.8） ml,first exhaust was （1.1±0.5） d,and hospitalization time after operation was（7.7±0.9） d in PTCL-treated patients,all significantly shorter or less than（247.6±30.5） min,（190.0±10.5） ml,（1.9±0.4） d and （10.0±1.2） d,respectively,in the open laparotomy （P<0.05）;after operation,the incidence of complications,such as incision infection,peritonitis,pulmonary infection or bile leak in PTCL-treated group was 3.0%,significantly less than 11.0% （x²=4.902,P<0.05） in patients receiving open laparotomy;two weeks after operation,serum ALT and AST levels in PTCL-treated group were （43.9±9.5） u/l and （40.3±8.9） u/l,not significantly different as compared to （42.3±10.2） u/l and （43.4±10.5） u/l in open laparotomy （P>0.05）,while serum bilirubin level was （18.9±3.2） μmol/l,significantly lower than （23.0±3.1） μmol/l（P<0.05） in open laparotomy;at the end of one year follow-up,the stone relapse as showed by ultrasound examination in PTCL-treated patients was 2.0%,significantly lower than 9.0% （x²=8.901,P<0.01） in open laparotomy;at the end of two year follow-up,the cumulated stone relapse in PTCL group was 3.0%,significantly lower than 15.0% （x²=11.071,P<0.01） in open laparotomy. Conclusion The application of percutaneous transhepatic choledochoscopic lithotripsy for treatment of patients with intrahepatic cholangiolithiasis might accelerate the rehabilitation and reduce postoperative complications and stone relapse,which warrants further investigation.

Key words: Intrahepatic cholelithiasis, Percutaneous transhepatic choledochoscopic lithotripsy, Rigid choledochoscopy, Complications, Relapse