经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石患者并发症发生及其影响因素分析*

doi:10.3969/j.issn.1672-5069.2020.04.037

摘要/Abstract

摘要： 目的分析经皮肝穿刺胆管造瘘电子胆道镜取石术(PTCSL)治疗肝内胆管结石(IHS)患者发生术后并发症的影响因素。方法 2015年5月～2019年5月我院消化内科就诊的115例IHS患者,其中60例接受PTCSL治疗,55例接受开腹手术。采用Logistic多因素回归分析影响术后并发症发生的因素。结果在两组,均顺利完成手术,取净结石;PTCSL组术后并发症发生率为21.7%,显著低于开腹组的49.1%(P<0.05),其中PTCSL组发生1例,开腹组发生4例下肢深静脉血栓,均经彩色多普勒超声检查早期发现,积极采取抗凝治疗后好转;术前白蛋白水平低、术中出血、有胆道手术史、术后发生胆汁多重耐药菌感染是影响PTCSL组患者发生并发症的因素(P<0.05);经多因素分析,术前白蛋白水平低【OR(95%CI)为0.5(0.3～0.9)】、术中出血【OR(95%CI)为2(1.4～3)】、胆道手术史【OR(95%CI)为1.9(1.3～2.7)】、术后胆汁多重耐药菌感染【OR(95%CI)为2.2(1.2～4.5)】是PTCSL组患者发生并发症的独立危险因素(P<0.05)。结论与常规开腹取石术相比,PTCSL可大大减少IHS患者术后并发症发生率,值得深入研究。

关键词: 肝内胆管结石, 经皮肝穿刺胆管造瘘电子胆道镜取石术, 并发症, 影响因素, 多因素分析

Abstract: Objective The aim of this study was to analyze the influencing factors of post-operational complications in patients with intrahepatic stone (IHS) after percutaneous transhepatic cholangioscopic lithotomy (PTCSL).Methods 115 patients with IHS were admitted to the Department of Digestive Diseases in our hospital between May 2015 and May 2019, and 60 received PTCSL and 55 received open operation. The factors impacting the post-operational complications were retrospectively evaluated by Logistic analysis. Results The total successful operation were carried out in our series, and the stones were pull out in the two groups; the incidence of postoperative complications in the PTCSL group was 21.7%, significantly lower than that in the laparotomy group (49.1%, P<0.05), of which, one case of lower limb deep vein thrombosis occurred in the PTCSL group, and four cases in open laparotomy group, all beening found early by color Doppler ultrasonography and improved after active anticoagulant therapy; low serum albumin level before operation, bleeding during operation, biliary tract operation history and bile multi-drug resistant bacteria infection after operation were the factors affecting complications in PTCSL group (P<0.05), and the Logistic analysis showed that low pre-operative serum albumin level [OR(95%CI) :0.5 (0.3-0.9)], hemorrhage during operation [OR(95%CI): 2 (1.4-3)], biliary tract surgery history [OR(95%CI):9 (1.3-2.7)], and bile multidrug-resistant bacteria infection [OR(95%CI):2.2 (1.2- 4.5)]were the independent risk factors for complications in the PTCSL group (P<0.05). Conclusion Compared with conventional laparotomy, PTCSL could greatly reduce the incidence of post-operational complications, which worth further investigation.

Key words: Intrahepatic stone, Percutaneous transhepatic cholangiostomy and electronic choledochoscope lithotomy: Complications, Influencing factors, Logistic analysis

黄庆勇, 张万里, 陈怡发, 刘黎明, 方菊梅. 经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石患者并发症发生及其影响因素分析^*[J]. 实用肝脏病杂志, 2020, 23(4): 601-604.

Huang Qingyong, Zhang Wanli, Chen Yifa, et al. Influencing factors ofpost-operational complications in patients with intrahepatic stone after percutaneous transhepatic cholangioscopic lithotomy[J]. Journal of Practical Hepatology, 2020, 23(4): 601-604.

参考文献

[1]Lu H, Yang H, Wu L, et al. A novel prognostic model for diagnosing atypical bile duct hyperplasia in patients with intrahepatic lithiasis. Medicine (Baltimore), 2019, 98(17): e15364.
[2]da Costa AC, Santa-Cruz F, Sena BF, et al. Dedifferentiated liposarcoma of the gallbladder: first reported case. World J Surg Oncol, 2018,16(1):221.
[3]Noviello C, Papparella A, Romano M, et al. Risk factors of cholelithiasis unrelated to hematological disorders in pediatric patients undergoing cholecystectomy. Gastroenterol Res, 2018,11(5):346-348.
[4]Schubiger G. Adult differentiation from partial drosophila embryos after egg ligation during stages of nuclear multiplication and cellular blastoderm. Dev Biol, 1976, 50(2): 476-488.
[5]Wang P, Chen X, Sun B, et al. Application of combined rigid choledochoscope and accurate positioning method in the adjuvant treatment of bile duct stones. Int J Clin Exp Med, 2015, 8(9): 16550-16556.
[6]李英宽, 索明果, 高聪聪, 等. 血清NGAL和Cys C对慢加急性肝衰竭患者并发肝肾综合征早期诊断价值研究. 实用肝脏病杂志, 2018, 21(4): 577-580.
[7]Kimura K, Kudo K, Kurihara T, et al. Rendezvous technique using double balloon endoscope for removal of multiple intrahepatic bile duct stones in hepaticojejunostomy after living donor liver transplant: a case Report. Transplant Proc, 2019, 51(2): 579-584.
[8]Ogura T, Okuda A, Miyano A, et al. Intrahepatic bile duct stone removal through endoscopic ultrasound-guided hepaticogastrostomy using novel basket catheter under digital cholangioscopy guidance. Endoscopy, 2018, 50(10): E301-E303.
[9]Chen C H, Lin C L, Hsu C Y, et al. A retrospective administrative database analysis of the association between clonorchiasis or helminthiasis and the development of cholelithiasis. Curr Med Res Opin, 2019, 35(3): 489-496.
[10]Chen C H, Lin C L, Kao C H. Association between inflammatory bowel disease and cholelithiasis: a nationwide population-based cohort study. Int J Environ Res Public Health, 2018, 15(3):216-219.
[11]Yuan L, Luo X, Lu X, et al. Comparison of clinicopathological characteristics between cirrhotic and non-cirrhotic patients with intrahepatic cholangiocarcinoma: a large-scale retrospective study. Mol Clin Oncol, 2017, 7(4): 615-622.
[12]Diaz-Cambronero O, Mazzinari G, Errando C L, et al. An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study. Trials, 2019, 20(1): 190.
[13]何启雄, 吴志扬, 黄铭祥, 等. 肝内外胆管结石多次手术原因及再次手术治疗方法和预后研究. 实用肝脏病杂志, 2018, 21(5): 781-784.
[14]Wang P, Sun B, Huang B, et al. Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 54-59.
[15]Schlesinger N H, Svenningsen P, Frevert S, et al. Percutaneous yttrium aluminum garnet-laser lithotripsy of intrahepatic stones and casts after liver transplantation. Liver Transpl, 2015, 21(6): 831-837.
[16]Yang J1, Zhang F, Du X, et al. Laparoscopic hepatectomy combined with endoscopic papillary balloon dilation for complex bile duct stones.ANZ J Surg, 2018, 88(6): E522-E525.
[17]Mesquita-Neto J, Mouzaihem H, Macedo F, et al. Perioperative and oncological outcomes of abdominoperineal resection in the prone position vs the classic lithotomy position: a systematic review with meta-analysis. J Surg Oncol, 2019, 119(7): 979-986.
[18]牛四明. 不同Calot三角解剖入路腹腔镜胆囊切除术治疗胆囊结石伴慢性胆囊炎患者疗效对比分析. 实用肝脏病杂志, 2018, 21(3): 447-450.
[19]Pan S, Li X, Jiang P, et al. Variations of abcb4 and abcb11 genes are associated with primary intrahepatic stones. Mol Med Rep, 2015, 11(1): 434-446.
[20]Tylicka M, Matuszczak E, Karpińska M, et al. Proteasome activity and C-reactive protein concentration in the course of inflammatory reaction in relation to the type of abdominal operation and the surgical technique used. Mediators Inflamm, 2018,2018:2469098.
[21]Hajjar R, Létourneau A, Henri M, et al. Cholecystocolonic fistula with a giant colonic gallstone: the mainstay of treatment in an acute setting. J Surg Case Rep, 2018,2018(10):278.

经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石患者并发症发生及其影响因素分析^*

Influencing factors ofpost-operational complications in patients with intrahepatic stone after percutaneous transhepatic cholangioscopic lithotomy

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李蔚,王锡斌,崔卫东,杨青,刘会苗,杨金雨,王锡斌. 超声引导下经皮经肝胆管穿刺引流术治疗急性梗阻性化脓性胆管炎患者疗效分析[J]. 实用肝脏病杂志, 2020, 23(3): 447-450.
[2]	唐浩, 宋文渊, 曾凯. 两种手术方法对严重外伤性肝破裂患者生存率的影响^*[J]. 实用肝脏病杂志, 2020, 23(2): 280-283.
[3]	毕洁领, 刘美宏, 宋国庆. Rouviere沟引导定向联合胆囊后三角入路腹腔镜胆囊切除术治疗胆囊良性疾病研究^*[J]. 实用肝脏病杂志, 2020, 23(2): 288-291.
[4]	周帅, 张剑权, 吕明. 完全腹腔镜手术治疗成人先天性胆总管囊肿患者疗效及安全性分析^*[J]. 实用肝脏病杂志, 2020, 23(1): 118-121.
[5]	钱国武, 崔广莹, 宋展, 吕柯, 刘驰, 孙万日. 腹腔镜规则性肝段或肝叶切除治疗复杂性肝内胆管结石患者血浆皮质醇和外周血T淋巴细胞亚群的变化^*[J]. 实用肝脏病杂志, 2020, 23(1): 122-125.
[6]	冯文广, 姜伟, 宋国军. PPV指导术中液体治疗对行肝部分切除术治疗的肝内胆管结石患者术后并发症发生的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 912-915.
[7]	丁雯瑾, 范建高. 胆汁淤积性肝病相关并发症的处理^*[J]. 实用肝脏病杂志, 2019, 22(6): 938-940.
[8]	邱军, 王雪清, 张波, 吕波. 经皮胆道造瘘碎石取石术治疗肝内胆管结石患者疗效分析[J]. 实用肝脏病杂志, 2019, 22(5): 744-747.
[9]	周启, 雷华娟, 赵振宇. 右美托咪啶对老年肝内胆管结石患者围术期脑功能保护作用研究*[J]. 实用肝脏病杂志, 2019, 22(5): 748-751.
[10]	彭思璐, 刘冰, 孙宏, 林剑, 潘志颖, 邓存良. HBV相关慢加急性肝衰竭患者预后及其影响因素分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 545-548.
[11]	祁莉娜, 颜梅, 郭建琴. 腹腔镜下肝囊肿开窗术与超声引导下穿刺介入治疗单纯性肝囊肿患者疗效对比研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 581-584.
[12]	卢西梅, 康燕飞, 宋智勇, 朱乔. 彩色多普勒超声检查诊断肝移植术后胆道并发症价值分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 589-592.
[13]	马信奎, 刘勇, 张伟. 经皮经肝胆道镜硬镜碎石术治疗肝内胆管结石患者临床疗效研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 593-596.
[14]	杜敏, 周敏, 纪宗淑, 刘海燕, 汤睿, 周亮, 高智. 脓毒症并发肝损伤患者临床特征及其危险因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 369-372.
[15]	德吉, 白玛, 白央, 米玛仓决. 慢性乙型肝炎和肝硬化患者肝脏硬度检测值的变化及其影响因素分析[J]. 实用肝脏病杂志, 2019, 22(3): 401-404.