经皮经肝I期胆道造瘘联合分步胆道镜治疗Roux-en-Y胆肠吻合术后结石复发的肝胆管结石患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.02.035

摘要/Abstract

摘要： 目的探讨经皮经肝I期胆道造瘘(PTOBF)联合分步经皮经肝胆道镜取石术(PTCSL)治疗Roux-en-Y胆肠吻合术经治复发的肝胆管结石患者的疗效。方法 2020年1月～2022年12月我院接受过Roux-en-Y胆肠吻合术治疗后结石复发的肝胆管结石患者83例, 其中31例对照组接受PTCSL取石术, 52例观察组接受PTOBF联合PTCSL取石术治疗、超声检查随访。结果观察组手术时间和术后住院日分别为(136.3±29.5)min和6.1(4.7, 7.8)d, 显著长于对照组【分别为(63.9±7.7)min和4.1(3.9, 5.2)d, P<0.05】;观察组一次穿刺成功率和一次瘘道扩张成功率分别为76.9%和94.2%, 显著高于对照组的54.8%和67.7%(P＜0.05);术前术后, 两组肝功能指标变化无显著性差异(P>0.05);术后观察组引流管脱出发生率为1.9%, 显著低于对照组的25.8%(P＜0.05), 而两组胆道出血和胸腔积液发生率无显著性差异(分别为1.9%对3.2%和3.9%对3.2%, P>0.05);术后随访7～43个月, 观察组结石再复发率为3.9%, 显著低于对照组的16.1%(P＜0.05)。结论采取PTOBF联合PTCSL术治疗复发性肝胆管结石患者效果显著, 且术中一次穿刺成功率和一次瘘道扩张成功率均较高, 术后引流管脱出和结石再复发率较低。

关键词: 肝胆管结石, 经皮经肝I期胆道造瘘取石术, 分步经皮经肝胆道镜取石术, 治疗, 复发

Abstract: Objective The aim of this study was to investigate re-operation of percutaneous transhepatic one-step biliary fistulation (PTOBF) and percutaneous transhepatic choledochoscope lithotomy (PTCSL) in treatment of patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy. Methods 83 patients with relapsed hepatolithiasis after Roux-en-Y cholangiojejunostomy were enrolled in our hospital between January 2020 and December 2022, and 31 cases in control group received PTCSL and 52 cases in observation group underwent PTOBF and PTCSL combination surgery. All patients in the two groups were followed-up by ultrasonography check-up. Results The operation time and post-operational hospital stay in the observation group were (136.3±29.5)min and 6.1(4.7, 7.8)d, much longer than in the control; the success rates of one-time puncture and one-time fistula dilation in the observation group were 76.9% and 94.2%, much higher than 54.8% and 67.7%(P＜0.05) in the control; there were no significant differences as respect to liver function tests in the two groups before and after operation(P>0.05); post-operationally, the shedding incidence of drainage tubes in the observation was 1.9%, much lower than 25.8%(P＜0.05) in the control, while there were no significant differences respect to the incidences of biliary bleeding and pleural effusion(1.9% vs. 3.2% and 3.9% vs. 3.2%, respectively, P>0.05) between the two groups; the post-operational follow-up showed the re-occurrence of intrahepatic stones in the observation was 3.9%, much lower than 16.1%(P＜0.05) in the control group. Conclusion The application of PTOBF and PTCSL combination in dealing with patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy is efficacious, with a good success rates of one-time puncture and one-time fistula dilation, and relatively low stone recurrence rates.

Key words: Hepatolithiasis, Percutaneous transhepatic one-step biliary fistulation, Percutaneous transhepatic choledochoscope lithotomy, Therapy, Recurrence

王卿, 栾娜, 叶刚. 经皮经肝I期胆道造瘘联合分步胆道镜治疗Roux-en-Y胆肠吻合术后结石复发的肝胆管结石患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(2): 299-302.

Wang Qing, Luan Na, Ye Gang. Re-operation of percutaneous transhepatic one-step biliary fistulation and percutaneous transhepatic choledochoscope lithotomy in treatment of patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy[J]. Journal of Practical Hepatology, 2024, 27(2): 299-302.

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经皮经肝I期胆道造瘘联合分步胆道镜治疗Roux-en-Y胆肠吻合术后结石复发的肝胆管结石患者疗效研究^*

Re-operation of percutaneous transhepatic one-step biliary fistulation and percutaneous transhepatic choledochoscope lithotomy in treatment of patients with recurrent hepatolithiasis after Roux-en-Y cholangiojejunostomy

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