消化道重建术后肝内外胆管结石经皮经肝胆道镜治疗的临床分析

doi:10.3877/cma.j.issn.1674-0793.2020.03.009

目的

探讨消化道重建术后肝内外胆管结石经皮经肝胆道镜（PTCS）治疗的临床价值。

方法

回顾性分析2014年3月至2018年6月什邡市人民医院行PTCS治疗的26例消化道重建术后肝内外胆管结石患者临床资料，分析PTCS临床治疗效果。

结果

3例术中扩张瘘管时误操作导致瘘管断裂后中转开腹，手术中转率为11.54%（3/26）。23例手术成功，成功率88.46%（23/26），其中1次取净结石9例（39.13%），2次6例（26.09%），3次6例（26.09%），4次2例（8.70%）。术后患者间接胆红素（IBIL）、直接胆红素（DBIL）和总胆红素（TBIL）均显著低于术前水平，差异有统计学意义（P<0.05）。随访8~41（19.03±4.06）个月，结石复发率为26.92%（7/26），再次行PTCS取石治疗，随访期间未再次复发。围手术期无一例死亡，并发症发生率为11.54%（3/26），其中1例术中胆道壁损伤后大量出血，2例术后发生胆管炎，给予对症治疗措施后好转。

结论

PTCS是治疗消化道重建术后肝内外胆管结石的有效手段。

关键词: 胆结石, 消化道重建, 经皮经肝胆道镜, 肝功能

Objective

To discuss the effects of percutaneous transhepatic cholangioscopy (PTCS) for intrahepatic and extrahepatic bile duct stones after digestive tract reconstruction.

Methods

A retrospectively analyze was made on the clinical data of twenty-six patients with intrahepatic and extrahepatic bile duct stones after digestive tract reconstruction treated by PTCS from March 2014 to June 2018 in Shifang People’s Hospital, and the clinical therapeutic effect of PTCS was evaluated.

Results

Three cases (11.54%) were converted to open surgery after fistula rupture due to misoperation during fistula dilation. The success rate of the operation was 88.46% (23/26), and calculi were taken out once in nine cases (39.13%), twice in six cases (26.09%), three times in six cases (26.09%), four times in two cases (8.70%). The levels of indirect bilirubin (IBIL), direct bilirubin (DBIL) and total bilirubin (TBIL) of patients after operation were significantly lower than those before operation (P<0.05). The stone recurrence rate was 26.92% (7/26) after 8-41 (19.03±4.06) months of follow-up, and PTCS was performed again. No recurrence or death occurred during the follow-up period. The incidence of perioperative complications was 11.54% (3/26), one case had massive bleeding due to injury of biliary wall during operation and two cases had cholangitis after operation. The complications were improved after symptomatic treatment.

Conclusion

PTCS is an effective method for the treatment of intrahepatic and extrahepatic bile duct stones after digestive tract reconstruction.

Key words: Cholelithiasis, Digestive tract reconstruction, Percutaneous transhepatic cholan-gioscopy, Liver function

表1 26例消化道重建术后肝内外胆管结石经皮经肝胆道镜治疗前后肝功能改善情况（μmol/L，±s）

指标	术前1 d	术后5 d	t值	P值
总胆红素	83.71±18.64	63.12±15.06	4.121	0.000
直接胆红素	48.69±12.16	38.29±9.38	3.248	0.002
间接胆红素	35.27±8.43	24.18±6.24	5.071	0.000
丙氨酸转氨酶	65.09±43.28	57.36±51.19	0.553	0.583
天冬氨酸转氨酶	80.24±83.06	74.59±71.36	0.247	0.806
碱性磷酸酶	235.17±138.42	248.26±167.23	0.289	0.774
谷氨酰转移酶	322.35±401.28	261.64±171.82	0.667	0.510

表1 26例消化道重建术后肝内外胆管结石经皮经肝胆道镜治疗前后肝功能改善情况（μmol/L，±s）

指标	术前1 d	术后5 d	t值	P值
总胆红素	83.71±18.64	63.12±15.06	4.121	0.000
直接胆红素	48.69±12.16	38.29±9.38	3.248	0.002
间接胆红素	35.27±8.43	24.18±6.24	5.071	0.000
丙氨酸转氨酶	65.09±43.28	57.36±51.19	0.553	0.583
天冬氨酸转氨酶	80.24±83.06	74.59±71.36	0.247	0.806
碱性磷酸酶	235.17±138.42	248.26±167.23	0.289	0.774
谷氨酰转移酶	322.35±401.28	261.64±171.82	0.667	0.510

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Clinical analysis of percutaneous transhepatic cholangioscopy for intrahepatic and extrahepatic bile duct stones after digestive tract reconstruction

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Clinical analysis of percutaneous transhepatic cholangioscopy for intrahepatic and extrahepatic bile duct stones after digestive tract reconstruction