PTBD联合二期PTCSL术治疗急性胆管炎伴胆总管结石患者疗效及安全性评价*

doi:10.3969/j.issn.1672-5069.2022.06.036

摘要/Abstract

摘要： 目的探讨采用经皮肝穿刺胆道引流术(PTBD)联合二期经皮经肝胆道镜取石术(PTCSL)治疗急性胆管炎伴胆总管结石患者的疗效及其安全性。方法 2017年5月～2020年5月常州市第七人民医院收治的急性胆管炎伴胆总管结石患者75例,均急诊接受PTBD手术治疗。在术后2～4 w,其中39例观察组患者接受二期PTCSL术治疗,另36例对照组接受腹腔镜胆囊切除术(LC)、腹腔镜胆道探查取石术(LCBDE)和T管引流术治疗。随访1年。结果术后,观察组肛门排气时间、引流管留置时间分别为(19.6±3.3)h和(7.8±1.2) h,与对照组的(20.4±3.5) h和(8.1±1.3) h比,差异均无统计学意义(P>0.05),而观察组手术时间和住院日分别为(86.9±14.1)min和(9.5±1.5)d,均显著短于对照组[分别为(124.6±19.8)min和(11.4±1.9)d,P<0.05];在术后24 h,观察组疼痛评分(2.1±0.3)分,显著低于对照组[(3.6±0.6)分,P<0.05];术后,观察组切口感染、胆漏、胰腺炎和胆道出血等并发症发生率为15.4%,与对照组的13.9%比,差异无统计学意义(P>0.05);随访发现,观察组结石残余和结石复发发生率分别为7.7%和15.4%,与对照组的8.3%和11.1%比,差异均无统计学意义(P>0.05)。结论本研究采用的两套手术方案治疗急性胆管炎伴胆总管结石患者均安全、有效,但采用二期PTCSL术治疗能够缩短手术时间和住院时间,减轻术后疼痛反应,似更合适。

关键词: 急性胆管炎, 胆总管结石, 经皮肝穿刺胆道引流术, 经皮经肝胆道镜取石术, 治疗

Abstract: Objective The aim of this study was to evaluate the efficacy and safety of percutaneous transhepatic biliary drainage (PTBD) and secondary percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of patients with acute cholangitis with choledocholithiasis. Methods 75 patients with acute cholangitis and choledocholithiasis were admitted to Changzhou Seventh People's Hospital between May 2017 and May 2020, and were divided into observation (n=39) and control group (n=36). All patients underwent emergency PTBD, and the patients in the observation group received second phase PTCSL and those in the control received laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE). All patients were followed-up for 12 months. Results The postoperative anal exhaust time and drainage tube indwelling time in the observation group were(19.6±3.3)h and (7.8±1.2) h, not significantly different compared to (20.4±3.5) h and (8.1±1.3) h in the control (P>0.05), while the operation time and hospital stay were (86.9±14.1)min and (9.5±1.5)d, both significantly shorter than [(124.6±19.8)min and (11.4±1.9)d, respectively, P<0.05] in the control group; 24 hours after operation, the visual analogue scale score in the observation group was (2.1±0.3), significantly lower than [(3.6±0.6), P<0.05] in the control; after operation, the incidence of complications, such as incision infection, bile leakage, pancreatitis and biliary bleeding in the observation group was 15.4%, not significantly different compared to 13.9% in the control (P>0.05); at the end of one-year follow-up, the incidences of residual stones and stone recurrence rates in the observation were 7.7% and 15.4%, not significantly different compared to 8.3% and 11.1% in the control (P>0.05). Conclusion PTBD combined with the second-stage PTCSL for the treatment of patients with acute cholangitis and common bile duct stones can shorten the operation time and hospital stay, reduce the amount of bleeding, and can reduce the postoperative pain response of the patient, which is safe and reliable.

Key words: Acute cholangitis, Choledocholithiasis, Percutaneous transhepatic biliary drainage, Percutaneous transhepatic choledochoscopic lithotomy, Therapy

陆晓明, 陈学敏. PTBD联合二期PTCSL术治疗急性胆管炎伴胆总管结石患者疗效及安全性评价^*[J]. 实用肝脏病杂志, 2022, 25(6): 901-904.

Lu Xiaoming, Chen Xuemin. Efficacy and safety of PTBD and two-stage PTCSL in the treatment of patients with acute cholangitis with choledocholithiasis[J]. Journal of Practical Hepatology, 2022, 25(6): 901-904.

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PTBD联合二期PTCSL术治疗急性胆管炎伴胆总管结石患者疗效及安全性评价^*

Efficacy and safety of PTBD and two-stage PTCSL in the treatment of patients with acute cholangitis with choledocholithiasis

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