CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析*

doi:10.3969/j.issn.1672-5069.2022.01.027

摘要/Abstract

摘要： 目的探讨在CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者的疗效和安全性。方法 2017年9月～2020年2月我院收治的60例复发性肝内胆管结石患者,其中31例(A组)接受CT引导下经皮肝穿刺胆道镜取石术(PTCSL)联合双频激光碎石取石治疗,另29例(B组)接受开腹手术治疗。采用化学发光免疫分析仪检测血清皮质醇(COR)和肾上腺素(EP)水平。结果 A组手术时间、肛门排气时间、首次排便时间和术后住院时间分别为(89.7±10.1)min、(30.3±3.6)h、(2.3±0.3)d和(6.9±1.1)d,显著短于B组【分别为(101.9±12.2)min、(34.7±4.1)h、(2.7±0.4)d和(11.8±1.6)d,P＜0.05】,术中出血量为(40.2±8.8)ml,显著少于B组[(97.4±10.6)ml,P＜0.05];在术后7 d,A组血白细胞计数、中性粒细胞百分比、血清COR和EP水平分别为(9.7±1.0)×10⁹/L、(67.8±5.9)%、(310.1±30.7)mmol/L和(210.7±22.8)pg/mL,显著低于B组【分别为(11.8±1.3)×10⁹/L、(76.4±7.1)%、(385.5±34.4)mmol/L和(247.3±23.1),P＜0.05】;A组血清ALT、AST、ALP和TBIL水平分别为(39.7±3.7)U/L、(39.9±4.1)U/L、(80.1±8.5)和(19.4±1.8)μmol/L,显著低于B组【分别为(45.6±5.1)U/L、(45.5±5.1)U/L、(85.9±6.8)和(23.0±3.4),P＜0.05】;A组术后并发症发生率为9.7%,显著低于B组的41.4%(P＜0.05);A组结石残余率为6.5%(2/31),显著低于B组的31.0%(9/29,P＜0.05)。结论与传统开腹手术相比,采取在CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者可减轻手术损伤,加快术后胃肠功能的恢复,可能与诱发的氧化应激和炎性反应较轻有关,同时其手术并发症和结石残留率也低。

关键词: 肝内胆管结石, 经皮肝穿刺胆道镜取石术, 双频激光碎石, 疗效

Abstract: Objective The aim of this clinical observation was to investigate the efficacy and safety of CT-guided percutaneous transhepatic choledochoscopic lithoteipsy (PTCSL) and dual-frequency laser lithotripsy (DFLL) combination in the treatment of patients with recurrent hepatolithiasis. Methods A total of 60 patients with recurrent hepatolithiasis were admitted to our hospital between September 2017 and February 2020, and 31 patients in group A received CT-guided PTCSL and DFLL and 29 patients in group B underwent open choledochofiberscope and DFLL. Serum cortisol (COR) and epinephrine (EP) were detected. Results The operation time, exhaust time, first defecation time and postoperative hospitalization stay in group A were(89.7±10.1)min, (30.3±3.6)h, (2.3±0.3)d and (6.9±1.1)d, all significantly shorter than [(101.9±12.2)min, (34.7±4.1)h, (2.7±0.4)d and (11.8±1.6)d, respectively, P＜0.05], while blood loss was (40.2±8.8)ml, much less than [(97.4±10.6)ml, P＜0.05] in group B; at the end of seven days after operation, the white blood cell counts, neutrophil percentage, serum COR and EP levels were (9.7±1.0)×10⁹/L, (67.8±5.9)%, (310.1±30.7)mmol/L and (210.7±22.8)pg/mL, significantly lower than [(11.8±1.3)×10⁹/L, (76.4±7.1)%, (385.5±34.4)mmol/L and (247.3±23.1), respectively, P＜0.05] in group B; serum ALT, AST, ALP and bilirubin level were (39.7±3.7)U/L, (39.9±4.1)U/L, (80.1±8.5) and (19.4±1.8)μmol/L, significantly lower than [(45.6±5.1)U/L, (45.5±5.1)U/L, (85.9±6.8) and (23.0±3.4), respectively, P＜0.05] in group B; the incidence of postoperative complications was 9.7%, significantly lower than 41.4% (P<0.05) and the stone residual rate was 6.5%, significantly lower than 31.0% in group B(P＜0.05). Conclusion CT-guided (PTCSL) and DFLL combination could reduce surgical damage, accelerate postoperative recovery of gastrointestinal functions with low stone residual rate, which might be related to less oxidative stress and inflammatory reaction.

Key words: Hepatolithiasis, Percutaneous transhepatic cholangioscopic lithotomy, Dual-frequency laser lithotripsy, Efficacy

王领, 魏志力, 宋平辉. CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2022, 25(1): 108-111.

Wang Ling, Wei Zhili, Song Pinghui. Efficacy and safety of CT-guided percutaneous transhepatic choledochoscopy and dual-frequency laser lithotripsy combination in the treatment of patients with recurrent hepatolithiasis[J]. Journal of Practical Hepatology, 2022, 25(1): 108-111.

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CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析^*

Efficacy and safety of CT-guided percutaneous transhepatic choledochoscopy and dual-frequency laser lithotripsy combination in the treatment of patients with recurrent hepatolithiasis

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