光纤胆道镜引导下经皮肝穿刺胆道镜取石术治疗肝内胆管结石的研究

靳浩, 崔敏

靳浩, 崔敏. 光纤胆道镜引导下经皮肝穿刺胆道镜取石术治疗肝内胆管结石的研究[J]. 实用临床医药杂志, 2021, 25(16): 54-56, 60. DOI: 10.7619/jcmp.20212138
引用本文: 靳浩, 崔敏. 光纤胆道镜引导下经皮肝穿刺胆道镜取石术治疗肝内胆管结石的研究[J]. 实用临床医药杂志, 2021, 25(16): 54-56, 60. DOI: 10.7619/jcmp.20212138
JIN Hao, CUI Min. Research on percutaneous transhepatic choledochoscopic lithotomy in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope[J]. Journal of Clinical Medicine in Practice, 2021, 25(16): 54-56, 60. DOI: 10.7619/jcmp.20212138
Citation: JIN Hao, CUI Min. Research on percutaneous transhepatic choledochoscopic lithotomy in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope[J]. Journal of Clinical Medicine in Practice, 2021, 25(16): 54-56, 60. DOI: 10.7619/jcmp.20212138

光纤胆道镜引导下经皮肝穿刺胆道镜取石术治疗肝内胆管结石的研究

基金项目: 

广东省医学科学技术研究基金资助项目 A2020424

详细信息
    通讯作者:

    崔敏, E-mail: haodoctorjin@foxmail.com

  • 中图分类号: R364.2;R61

Research on percutaneous transhepatic choledochoscopic lithotomy in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope

  • 摘要:
      目的  探讨新型光纤胆道镜(SFCS)引导下经皮肝穿刺胆道镜取石术(PTCSL)治疗肝内胆管结石的效果。
      方法  选取行PTCSL的患者129例,其中行常规PTCSL患者57例,行SFCS引导下PTCSL患者72例。根据治疗方法的不同将患者分为SFCS组(n=72)和常规组(n=57)。采用倾向评分匹配法对2组患者的基线指标进行平衡,匹配后2组分别有51例患者。比较2组患者手术时间、出血量、术后肠鸣音恢复时间、排便时间、术后住院时间及结石复发率。
      结果  SFCS组术中出血量少于常规组,手术时间、术后住院时间、术后肠鸣音恢复时间以及排便时间均短于常规组,差异有统计学意义(P < 0.05)。SFCS组术后复发率低于常规组。
      结论  新型SFCS具有视野清晰、镜身纤细、镜头灵活、操作方便、可联合冷激光碎石设备等优点, SFCS引导下PTCSL应用于肝内胆管结石患者的治疗安全有效。
    Abstract:
      Objective  To investigate the effect of percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope (SFCS).
      Methods  A total of 129 patients with PTCSL were selected, including 57 patients with conventional PTCSL and 72 patients with PTCSL guided by SFCS. Patients were divided into SFCS group (n=72) and conventional group (n=57) according to differed treatment methods. Propensity score matching method was used to balance the baseline indicators of patients in the two groups. After matching, there were 51 patients in each group. Operation time, blood loss, postoperative bowel sound recovery time, defecation time, postoperative hospital stay and stone recurrence rate were compared between the two groups.
      Results  The amount of intraoperative blood loss in the SFCS group was significantly less, the operation time, postoperative hospital stay, postoperative bowel sound recovery time and defecation time were significantly shorter than those in the conventional group (P < 0.05). The postoperative recurrence rate of the SFCS group was lower than that of the conventional group.
      Conclusion  The new SFCS has the advantages of clear field of vision, slim lens, flexible lens as well as convenient operation, and it can be combined with cold laser lithotripzer. PTCSL guided by SFCS is safe and effective in the treatment of patients with hepatolithiasis.
  • 图  1   SFCS引导下PTCSL的手术过程

    A: PTCSL前; B: PTCSL击碎结石过程; C、D: PTCSL完成后。

    表  1   2组匹配前后患者的基线特征[n(%)](x±s)

    基线特征 匹配前 匹配后
    SFCS组(n=72) 常规组(n=57) P SFCS组(n=72) 常规组(n=57) P
    年龄/岁 75.4±6.5 82.8±5.1 < 0.01 76.6±8.2 76.5±9.3 0.03
    性别 38(52.8) 31(54.4) < 0.01 26(51.0) 26(51.0) > 0.99
    34(47.2) 26(45.6) - 25(49.0) 25(49.0) -
    胆总管直径 ≥0.8 cm 40(55.6) 33(57.9) < 0.01 28(54.9) 28(54.9) > 0.99
    < 0.8 cm 32(44.4) 24(42.1) - 23(45.1) 23(45.1) -
    结石数目 ≥3个 39(54.2) 32(54.1) < 0.01 27(52.9) 27(52.9) > 0.99
    < 3个 33(45.8) 25(45.9) - 24(47.1) 24(47.1) -
    黄疸 41(56.9) 33(57.9) < 0.01 25(49.0) 25(49.0) > 0.99
    31(43.1) 24(42.1) - 26(51.0) 26(51.0) -
    下载: 导出CSV

    表  2   2组在倾向匹配后的手术结果(x±s)

    指标 SFCS组(n=51) 常规组(n=51)
    手术时间/min 120.4±5.6* 152.3±5.8
    失血量/mL 52.0±6.8* 80.2±7.2
    复发率/% 0 3.9
    住院时间/d 3.2±0.8* 5.2±0.9
    术后肠鸣音恢复时间/d 1.2±0.5* 1.8±0.9
    排便时间/d 2.3±0.4* 3.0±0.3
    与常规组比较, *P < 0.05。
    下载: 导出CSV
  • [1]

    LORIO E, PATEL P, ROSENKRANZ L, et al. Management of hepatolithiasis: review of the literature[J]. Curr Gastroenterol Rep, 2020, 22(6): 30. doi: 10.1007/s11894-020-00765-3

    [2] 孙光明, 唐明杰, 刘敬华. 浅析影响接受根治性手术后肝内胆管细胞癌患者预后的因素[J]. 当代医药论丛, 2021(12): 6-8. doi: 10.3969/j.issn.2095-7629.2021.12.004
    [3]

    KOUKOURA O, KELESIDOU V, DELIANIDOU M, et al. Prenatal sonographic diagnosis of biliary tract malformations[J]. J Clin Ultrasound, 2019, 47(5): 292-297. doi: 10.1002/jcu.22705

    [4] 张鸿渐, 张恒, 段小辉, 等. 全脏器反位肝内胆管结石行腹腔镜左肝外叶切除术一例[J]. 中华普通外科杂志, 36(4): 1-1.
    [5]

    YOSHIDA H, TANIAI N, YOSHIOKA M, et al. Current status of laparoscopic hepatectomy[J]. J Nippon Med Sch, 2019, 86(4): 201-206. doi: 10.1272/jnms.JNMS.2019_86-411

    [6]

    FENG L B, XIA D, YAN L N. Liver transplantation for hepatolithiasis: Is terminal hepatolithiasis suitable for liver transplantation[J]. Clin Transplant, 2016, 30(6): 651-658. doi: 10.1111/ctr.12731

    [7]

    CHA S W. Management of intrahepatic duct stone[J]. Korean J Gastroenterol, 2018, 71(5): 247-252. doi: 10.4166/kjg.2018.71.5.247

    [8]

    RITTER M, RASSWEILER M C, MICHEL M S. Complications in percutaneous lithotomy[J]. Urologe A, 2014, 53(7): 1011-1016. doi: 10.1007/s00120-014-3503-7

    [9] 中国医师协会内镜医师分会, 中华医学会消化内镜学分会, 国家消化系统疾病临床医学研究中心(上海). 中国胆道结石双频双脉冲激光碎石专家建议[J]. 中华肝胆外科杂志, 2021, 27(3): 161-163. doi: 10.3760/cma.j.cn113884-20210223-00067
    [10]

    ZHUO H, CHEN Z, LIN R, et al. Percutaneous transhepatic choledochoscopic lithotomy (PTCSL) is effective for the treatment of intrahepatic and extrahepatic choledocholithiasis[J]. Surg Laparosc Endosc Percutan Tech, 2020, 31(3): 326-330. http://journals.lww.com/surgical-laparoscopy/Abstract/9000/Percutaneous_Transhepatic_Choledochoscopic.99172.aspx

    [11] 王帅, 任昊桢, 汤宁, 等. 机器人、腹腔镜以及开腹肝切除术治疗肝内胆管结石的对比研究[J]. 南京医科大学学报: 自然科学版, 2021, 41(1): 82-87. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK202101015.htm
    [12] 陈江明, 濮天, 谢青松, 等. 吲哚菁绿荧光导航辅助腹腔镜肝内胆管良性区域梗阻型病变区段肝切除可行性及疗效分析[J]. 中国实用外科杂志, 2021, 41(4): 419-422. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202104020.htm
图(1)  /  表(2)
计量
  • 文章访问数: 
  • HTML全文浏览量: 
  • PDF下载量: 
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-05-21
  • 网络出版日期:  2021-09-03
  • 发布日期:  2021-08-27

目录

    /

    返回文章
    返回