经皮肝穿刺胆道镜取石术治疗肝内胆管结石的临床疗效研究

发布时间：2018-10-17 08:55

【摘要】：目的：探讨经皮肝穿刺胆道镜取石术在肝内胆管结石微创治疗的可行性和临床应用价值,尤其在复杂性肝内胆管结石治疗中的优势。方法：回顾性分析45例肝内胆管结石患者的临床资料,(男性患者19例,女性患者26例,年龄20-84岁。分为实验组、对照组,实验组行经皮肝穿刺胆道镜取石术,对照组行传统手术,主要以胆总管切开取石、T管引流术为主,必要时结合肝叶切除术、胆肠吻合术等。比较两组术后残余结石率、术后并发症、术后1年结石复发率等。结果：最终共有43例病例可评价,实验组有2例患者因穿刺失败中转开腹手术。①两组在结石清除率,术后肝功能恢复,术后1年结石复发率方面差异无统计学意义(P0.05)。②实验组在术中出血、手术时间、术后并发症、术后胃肠功能恢复、手术切口、疼痛评分等方面优于对照组(P0.05)。结论：经皮肝穿刺胆道镜取石术可达到微创治疗肝内胆管结石、保护肝功能的目的,本方法具有创伤小、并发症少、取石率高、残石率低、术后疼痛轻等优点。
[Abstract]:Objective: to investigate the feasibility and clinical value of percutaneous transhepatic choledocholithotomy in the minimally invasive treatment of intrahepatic cholelithiasis, especially in the treatment of complicated intrahepatic cholelithiasis. Methods: the clinical data of 45 patients with intrahepatic cholelithiasis were retrospectively analyzed (19 male and 26 female, aged 20-84 years). The patients were divided into experimental group, control group, the experimental group underwent percutaneous transhepatic choledochoscopy, and the control group underwent traditional operation, mainly by choledocholithotomy, T-tube drainage, liver lobectomy and cholangiojejunostomy when necessary. The rate of residual stones, postoperative complications and recurrence rate of stone were compared between the two groups. Results: a total of 43 cases could be evaluated. In the experimental group, 2 cases were converted to open operation due to the failure of puncture. 1 in the two groups, the stone clearance rate and liver function were recovered after operation. There was no significant difference in the recurrence rate of calculi 1 year after operation (P0.05). 2 the experimental group was superior to the control group in the aspects of intraoperative bleeding, operation time, postoperative complications, postoperative gastrointestinal function recovery, surgical incision, pain score and so on (P0.05). Conclusion: percutaneous transhepatic choledochoscopic lithotomy can achieve the purpose of minimally invasive treatment of intrahepatic cholelithiasis and protection of liver function. This method has the advantages of less trauma, less complications, higher lithotomy rate, lower residual stone rate and less postoperative pain.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R657.4

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