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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2017, Vol. 10 ›› Issue (02) : 85 -88. doi: 10.3877/cma.j.issn.1674-6899.2017.02.006

所属专题： 文献；

论著

超声引导经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石
李炳根1,†(), 梁璇坤2, 邱敏捷3, 聂向阳1, 彭永辉1, 龚独辉1, 谢志华1, 莫宇轩1, 李达强1   
  1. 1. 511400　广州，南方医科大学附属何贤纪念医院普通外科
    2. 511400　广州，南方医科大学附属何贤纪念医院超声科
    3. 511400　广州，南方医科大学附属何贤纪念医院泌尿外科
  • 收稿日期:2016-10-12 出版日期:2017-04-30
  • 通信作者: 李炳根

Ultrasound guided-percutaneous transhepatic cholangioscopic one-stage lithotomy with rigid choledochoscope for hepatolithiasis

Binggen Li1,†(), Xuankun Liang2, Minjie Qiu3, Xiangyang Nie1, Yonghui Peng1, Duhui Gong1, Zhihua Xie1, Yuxuan Mo1, Daqiang Li1   

  1. 1. Department of General Surgery, Hexian Memorial Affiliated Hospital of Southern Medical University, Guangzhou 511400, China
    2. Department of Ultrasonography, Hexian Memorial Affiliated Hospital of Southern Medical University, Guangzhou 511400, China
    3. Department of Urinary Surgery, Hexian Memorial Affiliated Hospital of Southern Medical University, Guangzhou 511400, China
  • Received:2016-10-12 Published:2017-04-30
  • Corresponding author: Binggen Li
  • About author:
    Corresponding author: Li Binggen, Email:
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引用本文：

李炳根, 梁璇坤, 邱敏捷, 聂向阳, 彭永辉, 龚独辉, 谢志华, 莫宇轩, 李达强. 超声引导经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石[J/OL]. 中华腔镜外科杂志(电子版), 2017, 10(02): 85-88.

Binggen Li, Xuankun Liang, Minjie Qiu, Xiangyang Nie, Yonghui Peng, Duhui Gong, Zhihua Xie, Yuxuan Mo, Daqiang Li. Ultrasound guided-percutaneous transhepatic cholangioscopic one-stage lithotomy with rigid choledochoscope for hepatolithiasis[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2017, 10(02): 85-88.

目的

探讨超声引导经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石的可行性及疗效。

方法

2013年1月至2016年1月期间，南方医科大学附属何贤纪念医院的21例肝胆管结石患者，均采用超声引导经皮肝穿刺一期硬质胆道镜碎石术。

结果

21例患者手术均成功，无中转手术。18例(85.7%)患者最终取净结石，其中1次结石取净者14例(66.7%)。手术时间(95.7 ± 21.0)min，术中出血量(15.1 ± 7.6)ml，住院时间(11.6 ± 4.3)d。术后发生并发症4例，其中1例出现胆瘘并局部胆汁性腹膜炎，经超声定位穿刺置管引流后痊愈；2例出现右侧少量胸腔积液，1例出现右下肺盘状不张，均经过保守治疗后痊愈。无术后胆道感染或胆道出血，无死亡病例。所有患者均获得随访，随访8～44个月，4例(19.0%)出现结石复发。

结论

超声引导下经皮肝穿刺一期硬质胆道镜碎石术治疗肝胆管结石安全有效、创伤小，提高了碎石取石效率，缩短患者住院时间。

关键词: 肝胆管结石, 经皮肝穿刺胆道造瘘, 胆道镜, 碎石术
Objective

To analyze the feasibility and efficiency of ultrasound guided-percutaneous transhepatic cholangioscopic (PTCS) one-stage lithotomy with rigid choledochoscope for the treatment of hepatolithiasis.

Methods

From Jan. 2013 to Jan. 2016. Twenty one cases of hepatolithiasis patients were enrolled. All of them were treated by PTCS one-stage lithotomy with rigid choledochoscope. Clinical data were collected and analyzed retrospectively.

Results

All surgeries were successful without conversion. All the stones were removed eventually in 85.7% (18/21), 14 cases(66.7%) achieved this clearance in one episode. The mean operation time was(95.7 ± 21.0)min. Mean blood loss was(15.1 ± 7.6)ml. Average hospital stay was(11.6 ± 4.3)d. Four patients suffered from mild to moderate complications. All of them were managed properly, with no major impact on the final outcome. All patients were followed-up for 8 to 44 months. 4 cases(19.0%) of recurrences were noticed.

Conclusions

Ultrasound guided PTCS one-stage lithotomy with rigid choledochoscope was a safe and feasible procedure. It was minimally invasive and highly efficient which result in shortening patients′ hospital stay. Therefore it might be a worthy alternative for the treatment of hepatolithiasis.

Key words: Hepatolithiasis, Percutaneous transhepatic cholangiostomy, Choledochoscope, Lithotomy
图1 肝胆管结石患者的超声引导穿刺目标胆管并一期扩张窦道
图2 肝胆管结石患者的超声监视将18 F鞘管套在相应的扩张器上并送入目标胆管
图3 肝胆管结石患者的硬质胆道镜下碎石、取石
1
黄志强. 黄志强胆道外科[M]. 济南：山东科学技术出版社，1998: 549-607.
2
Nimura Y, Hayakawa N, Toyoda S, et al. Percutaneous transhepatic cholangioscopy[J]. Stomach Intestine, 1981, 16(2): 681-689.
3
余国忠，方锦标，聂向阳，等. 联合应用硬直胆镜与纤维胆管镜治疗胆管术后残石的疗效分析[J]. 医学综述，2013, 19(10): 1883-1885.
4
余国忠，聂向阳，何永忠，等. 硬直胆镜与纤维胆道镜在胆道结石治疗中的应用比较[J]. 广东医学，2013, 34(4): 566-567.
5
董家鸿，黄志强. 规则性肝段切除术治疗肝内胆管结石病[J]. 中华普通外科杂志，2002, 17(7): 418-420.
6
谢应海，胡敏，王爱民，等. 肝内胆管结石126例外科治疗体会[J]. 肝胆外科杂志，2011, 19(3): 206-208.
7
Ping W, Chen X, Sun B, et al. Application of combined rigid choledochoscope and accurate positioning method in the adjuvant treatment of bile duct stones[J]. International Journal of Clinical & Experimental Medicine, 2015, 8(9): 16550-16556.
8
Lee JH, Kim HW, Kang DH, et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones[J]. Clinical Endoscopy, 2013, 46(1): 65-70.
9
张宝善，山川达郎，三芳端. 经皮经肝胆道镜的临床应用[J]. 中华外科杂志，1985, 23(6): 353-355.
10
何炼图，汤庆，陈绮璐，等. 超声引导在经皮肝胆道镜治疗肝胆管结石中的应用[J]. 中华生物医学工程杂志，2015(1): 81-83.
11
Jeng KS, Chiang HJ, Shih SC. Limitations of percutaneous transhepatic cholangioscopy in the removal of complicated biliary calculi[J]. World Journal of Surgery, 1989, 13(5): 603.
12
时鑫，刘衍民，文辉清，等. 经皮肝胆道造瘘硬质胆道镜治疗肝内胆管结石[J/CD]. 中华腔镜外科杂志(电子版), 2010, 3(5): 393-395.
13
方锦标，聂向阳，邱敏捷，等. 硬质胆道镜联合气压腔内碎石治疗肝内胆管结石的价值[J]. 重庆医学，2008, 37(18): 2090-2091.
14
徐恕，张剑权，符国珍，等. 经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石的近远期疗效[J]. 中华普通外科杂志，2016, 31(3): 212-214.
15
Chen CH, Huang MH, Yang JC, et al. Reappraisal of percutaneous transhepatic cholangioscopic lithotomy for primary hepatolithiasis[J]. Surgical Endoscopy, 2005, 19(4): 505-509.
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