经皮经肝穿刺一期硬质胆道镜联合气压弹道碎石取石术治疗肝内胆管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.06.033

摘要/Abstract

摘要： 目的总结经皮经肝穿刺一期硬质胆道镜联合气压弹道碎石(PL)取石术治疗肝内胆管结石(IBDS)患者的效果。方法 2022年10月～2024年10月我院收治的69例IBDS患者,按不同手术方法分为两组,在对照组(n=25)采取常规开腹手术,在观察组(n=44)采取经皮经肝穿刺一期硬质胆道镜联合PL取石术。随访半年,比较治疗效果。结果观察组手术时间、出血量、下床时间和住院日分别为(132.6±19.8)min、(20.4±4.33)mL、(1.6±0.4)d和(6.6±1.2)d,显著少于或短于对照组【分别为(182.6±19.1)min、(200.6±15.3)mL、(2.5±0.7)d和(9.7±1.4)d,P＜0.05】;术后观察组血清TBIL、ALT和AST水平分别为(18.6±2.7)μ mol/L、(40.0±3.9)U/L和(38.0±3.7)U/L,均显著低于对照组【分别为(23.6±3.1)μ mol/L、(53.9±4.0)U/L和(49.9±4.0)U/L, P＜0.05】;术后观察组切口感染、胆漏、胆道出血和胸腹腔积液等并发症发生率为13.6%,显著低于对照组的52.0%(P＜0.05);观察组结石清除率为93.2%,显著高于对照组的60.0%(x²=11.479,P=0.001);术后6个月观察组结石复发率为6.8%,显著低于对照组的32.0%(x²=4.899,P=0.027)。结论采取经皮经肝穿刺一期硬质胆道镜取石术联合PL取石术治疗IBDS患者能够显著提高结石清除率,降低结石复发率,值得临床开展大规模研究。

关键词: 肝胆管内结石, 经皮经肝穿刺一期硬质胆道镜取石术, 气压弹道碎石取石术, 治疗

Abstract: Objective The aim of this study was to investigate percutaneous transhepatic one-stage rigid choledochoscopyfollowed by pneumatic lithotripsy (PL) in the treatment of patients with intrahepatic bile duct stones (IBDS). Methods 69 patients with IBDS were encountered in our hospital between October 2022 and October 2024, and 25 patients in control were assigned to undergo open surgery, and 44 patients in observation were assigned to receive percutaneous transhepatic puncture with one-stage rigid choledochoscopy followed by PL for stone removal. All patients were followed-up for six months after operation. Result The operation time, intraoperational blood loss, postoperative ambulation time and hospital stay in the observation group were (132.6±19.8)min, (20.4±4.33)mL, (1.6±0.4)d and (6.6±1.2)d, all significantly less or shorter than [(182.6±19.1)min, (200.6±15.3)mL, (2.5±0.7)d and (9.7±1.4)d, respectively, P＜0.05] in the control group; post-operationally, total serum bilirubin, ALT and AST levels in the observation were (18.6±2.7)μ mol/L, (40.0±3.9)U/L and (38.0±3.7)U/L, all much lower than [(23.6±3.1)μ mol/L, (53.9±4.0)U/L and (49.9±4.0)U/L, respectively, P＜0.05] in the control; incidence of complications, such as incision infection, biliary leakage, biliary bleeding and pleural and peritoneal effusion in the observation group was 13.6%, much lower than 52.0%(P＜0.05) in the control; stone clearance rate was 93.2%, much higher than 60.0%(x²=11.479, P=0.001) in the control ,and six-months after surgery, the stone recurrence rate was 6.8%, much lower than 32.0%(x²=4.899, P=0.027) in the control group. Conclusion Percutaneous transhepatic puncture for one-stage rigid choledochoscopy lithotomy followed by PL in patients with IBDS could significantly improve stone clearance rate and decrease the recurrence rate, which warrants large-scale clinical investigation.

Key words: Intrahepatic bile duct stones, One-stage percutaneous transhepatic rigid choledochoscopy, Pneumatic lithotripsy, Therapy

陈晨, 朱恽, 陆菊, 汪蕾. 经皮经肝穿刺一期硬质胆道镜联合气压弹道碎石取石术治疗肝内胆管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 930-933.

Chen Chen, Zhu Yun, Lu Ju, et al. Percutaneous transhepatic one-stage rigid choledochoscopy followed by pneumatic lithotripsyin the treatment of patients with intrahepatic bile ductstones[J]. Journal of Practical Hepatology, 2025, 28(6): 930-933.

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经皮经肝穿刺一期硬质胆道镜联合气压弹道碎石取石术治疗肝内胆管结石患者疗效研究^*

Percutaneous transhepatic one-stage rigid choledochoscopy followed by pneumatic lithotripsyin the treatment of patients with intrahepatic bile ductstones

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