【摘要】 目的:对比经皮肝穿刺胆管造瘘电子胆道镜取石术(PTCSL)与开腹下肾镜取石术在复发性肝内外胆管结石中的治疗效果。方法:选取2013年7月至2016年7月本院收治的复发性肝内外胆管结石患者108例,按随机数字表法将其分为开腹组与经皮肝穿刺组,每组54例。开腹组实施开腹手术治疗,经皮肝穿刺组实施PTCSL。于术后3个月评估两组手术疗效,记录患者切口长度、手术时间、术中出血量、肛门首次排气时间、术后进食时间、住院时间。比较两组术后结石残留率、并发症发生率及术后12个月内的结石复发率。结果:经皮肝穿刺组手术优良率为83.33%,开腹组为64.81%,两组比较差异有统计学意义(P<0.05)。经皮肝穿刺组的切口长度、手术时间、肛门首次排气时间均短于开腹组,术中出血量少于开腹组,差异均有统计学意义(均P<0.05)。经皮肝穿刺组结石残留率为7.41%,显著低于开腹组的22.22%(P<0.05)。经皮肝穿刺组并发症发生率为3.70%,明显低于开腹组的20.37%(P<0.05)。经皮肝穿刺组术后12个月内的结石复发率(14.81%)与开腹组(18.52%)比较差异无统计学意义(P>0.05)。结论:与传统开腹手术相比,经皮肝穿刺术更有利于促进患者术后恢复,结石残留率、并发症发生率低,手术疗效显著,值得临床推广。更多还原

【Abstract】 Objective:To compare the clinical effects of percutaneous transhepatic cholangioscopic lithotomy(PTCSL)and open nephrolithotomy for recurrent intrahepatic and extrahepatic bile duct stones(BDS).Methods:From July 2013 to July 2016,108 patients with recurrent intrahepatic and extrahepatic BDS were selected,and randomly divided into a laparotomy group and a percutaneous transhepatic group,with 54 cases in each group.The patients in laparotomy group received open nephrolithotomy,and those in the percutaneous transhepatic group received PTCSL.The incision length,operation time,blood-loss volume,exhaust time,postoperative eating time,and hospital days were recorded.Postoperative residual stone rate,the incidence of complications and the recurrence rate within one year were compared.Results:The excellent rate in the percutaneous transhepatic group was higher than that in the laparotomy group(83.33% vs.64.81%,P<0.05),while the incision length,operation time,exhaust time and the blood-loss volume were lower(P<0.05).The residual stone rate in the percutaneous transhepatic group was 7.41%,which was significantly lower than that in the laparotomy group(22.22%)(P<0.05).The incidence of complications in the percutaneous transhepatic group was 3.70%,which was lower than that in the laparotomy group(20.37%)(P<0.05).There was no significant difference in the recurrence rate of calculi between the two groups(14.81%vs.18.52%,P>0.05).Conclusion:PTCSL was more effective in the treatment of recurrent intrahepatic and extrahepatic BDS than open nephrolithotomy.It could promote patients’ recovery,reduce residual stone rate and the incidence of complications.更多还原