经皮经肝取石术治疗胆总管结石25例

发布时间：2019-01-24 13:42

【摘要】：目的探讨经皮经肝胆结石取出术治疗胆总管结石的临床应用价值。方法自2013年1月至2015年1月,25例胆总管结石患者采用经皮经肝途径取石。首先在超声或者X线透视引导下完成PTC并放置8 F鞘;然后采用8~12 mm球囊扩张乳头,如结石直径超12 mm,加用网篮碎石;最后采用取石球囊通过交换导丝将结石经十二指肠乳头括约肌推至肠道内。结果 25例患者包括胃肠道术后(18例)、内镜治疗失败(3例)、不愿意接受内镜治疗(3例)、其他情况(1例)。25例患者均成功取出结石。术后3例(12%)发生并发症,分别为发热2例、肝脓肿形成1例,随访6个月到3年,2例患者因原患肿瘤复发转移死亡,1例患者胆总管结石复发,无反流性胆管炎发生。结论经皮经肝胆结石取出术治疗胆总管结石具有较高的手术成功率以及较低的并发症发生率,可以作为不适合内镜治疗或者内镜治疗失败的胆总管结石患者的治疗措施。
[Abstract]:Objective to evaluate the clinical value of percutaneous transhepatic cholelithiasis removal in the treatment of choledocholithiasis. Methods from January 2013 to January 2015, 25 patients with choledocholithiasis underwent percutaneous transhepatic lithotomy. PTC was completed under the guidance of ultrasound or X-ray fluoroscopy and 8F sheath was placed, then the papilla was dilated with 8 ~ 12 mm balloon, such as stone diameter more than 12 mm, and net basket lithotripsy. Finally, stone balloon was used to push stones through duodenal papillary sphincter into the intestine. Results Twenty-five patients, including 18 cases of gastrointestinal tract operation, 3 cases of failure of endoscopic treatment, 3 cases of unwillingness to receive endoscopic treatment, and 1 case of other cases, all of them successfully removed stones. Postoperative complications occurred in 3 cases (12%), including 2 cases of fever and 1 case of liver abscess. Follow-up for 6 months to 3 years showed that 2 patients died of recurrence and metastasis of primary tumor, 1 patient with choledocholithiasis recurred and no reflux cholangitis occurred. Conclusion Percutaneous transhepatic cholelithiasis removal has a high surgical success rate and a low incidence of complications. It can be used as a treatment for choledocholithiasis patients who are not suitable for endoscopic therapy or failed in endoscopic treatment.
【作者单位】：苏北人民医院介入放射科;苏北人民医院消化内科;
【分类号】：R657.42

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