【摘要】 目的:探讨经皮肝穿刺胆道镜取石术治疗肝内外胆道结石的疗效及安全性。方法:回顾性分析92例肝内外胆道结石患者的临床资料,其中行经皮肝穿刺胆道镜取石术(观察组)32例,行传统胆总管切开取石术+T管引流术(对照组)60例。对比两组临床疗效(结石取尽率、术后结石复发率)、手术相关指标及术后康复指标(手术时间、术中出血、切口长度、术后排气时间、禁食时间、住院时间)、肝功能指标丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(STB)及术后并发症发生率。结果:两组结石取尽率、术后结石复发率比较无显著差异(P>0.05)。观察组手术时间、术中出血、切口长度、术后排气时间、禁食时间均显著低于对照组(P<0.05)。两组术后ALT、AST、STB均较术前显著降低(P<0.05),但组间各肝功能指标比较无显著差异(P>0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:经皮肝穿刺胆道镜取石术与传统手术治疗肝内外胆道结石疗效相当,且均可改善患者肝功能,但前者具有微创优势,创伤小,术后恢复快,并发症发生率低,更具临床应用价值。更多还原

【Abstract】 Objective: To investigate the efficacy and safety of percutaneous transhepatic choledochoscopy in the treatment of intrahepatic and extrahepatic bile duct stones. Method: The clinical data of 92 patients with intrahepatic and extrahepatic biliary calculi in our hospital were retrospectively analyzed. Among them,32 cases underwent percutaneous transhepatic choledochoscopy( observation group),60 cases underwent conventional common bile duct lithotomy and T tube drainage( control group). The clinical efficacy( stone clearance rate,postoperative stone recurrence rate),operative related indexes( operation time,intraoperative bleeding,incision length,postoperative exhaust time,fasting time,hospitalization time),postoperative rehabilitation indexes [alanine aminotransferase( ALT),aspartate aminotransferase( AST),total bilirubin( STB) ],liver function indexes and postoperative complications were compared between the two groups. Results: There was no significant difference in stone removal rate and postoperative stone recurrence rate between the two groups( P > 0.05). The operation time,intraoperative bleeding,incision length,postoperative exhaust time and fasting time in the observation group were significantly lower than those in the control group( P <0.05). The postoperative ALT,AST and STB of the two groups were significantly lower than those before operation( P < 0.05),but there was no significant difference between the two groups in liver function index( P >0.05). The incidence of complications in the observation group was lower than that in the control group,the difference was statistically significant( P < 0. 05). Conclusion: Percutaneous transhepatic choledochoscopy and traditional surgery are effective in the treatment of intrahepatic and extrahepatic bile duct stones,and can improve the liver function of patients. But the former has the advantages of minimally invasive,less trauma,rapid postoperative recovery,low incidence of complications,and has more clinical value.更多还原