2019 年第 6 期 第 14 卷

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临床效果与术后并发症危险因素分析

Clinical effect of percutaneous transhepatic cholangioscopic lithotomy on intrahepatic cholelithiasis and the risk factors of postoperative complications

作者：黄玉斌蔡小勇靳小建黄飞晏益核李建军黄俊

英文作者：

单位：530000南宁，广西医科大学第二附属医院普通外科

英文单位：

关键词：肝内胆管结石；肝切除术；经皮肝穿刺取石术；并发症；危险因素

英文关键词：

• 摘要：

• 【摘要】目的    探讨经皮肝穿刺胆管造瘘电子胆道镜取石术(PTCSL)治疗肝内胆管结石(IHS)的临床效果并分析术后发生并发症的危险因素。方法    选取2013年5月至2017年5月在广西医科大学第二附属医院就诊的IHS患者145例作为研究对象。将入组患者根据术式不同分为对照组（75例）和观察组（70例）。对照组行常规开腹取石手术，观察组行PTCSL，比较2组患者手术切口长度、手术时间、术中出血量、术后胃肠功能恢复时间。术后至2018年6月共136例患者完成随访，观察组65例，对照组71例，比较2组患者结石复发率和并发症发生率，分析PTCSL治疗IHS患者发生并发症的危险因素。结果    观察组手术切口长度短于对照组［（1.35±0.25）cm比（13.23±0.36）cm］，术中出血量、手术时间及术后胃肠功能恢复时间均短于对照组［（100±12）ml比（331±15）ml、（42±7）min比（75±8）min、（6.0±2.4）h比（75.2±13.2）h］，差异均有统计学意义(均P＜0.05)。对照组与观察组术后结石复发率比较［22.5%(16/71)比26.2%(17/65)］，差异无统计学意义(P=0.623)；观察组术后并发症发生率明显低于对照组［27.7%(18/65)比60.6%(43/71)］，差异有统计学意义（P=0.001）。多因素Logistic回归分析结果显示，术前白蛋白及术中胆汁多重耐药菌感染是PTCSL治疗IHS患者术后发生并发症的独立危险因素（均P＜0.05）。结论    与传统开腹取石术相比，PTCSL治疗IHS的安全性高，结石复发率相当，并发症发生率明显降低。行PTCSL术前应对手术环境进行全面清洁，同时应重视患者术前白蛋白水平，尽一切可能规避手术风险，提高手术治疗效果。

• 【Abstract】Objective    To investigate the clinical efficacy and risk factors of percutaneous transhepatic cholangioscopic lithotomy(PTCSL) for intrahepatic cholelithiasis(IHS). Methods    A total of 145 IHS patients admitted to the Second Affiliated Hospital of Guangxi Medical University between May 2013 and May 2017 were assigned into control group（75 cases） receiving routine laparotomy plus lithotomy and observation group（70 cases） receiving PTCSL. Incision length, operation time, intraoperative blood loss and postoperative recovery time of gastrointestinal function were recorded. Finally 136 patients completed the follow-up before June 2018, including 65 cases in observation group and 71 cases in control group. Recurrence rate and complication rate were observed. Risk factors of complications after PTCSL were analyzed. Results    Incision length, intraoperative blood loss, operation time and postoperative recovery time of gastrointestinal function in observation group were significantly shorter than those in control group［（1.35±0.25）cm vs （13.23±0.36）cm, （100±12）ml vs （331±15）ml, （42±7）min vs （75±8）min, （6.0±2.4）h vs （75.2±13.2）h］(P＜0.05). There was no significant difference of the recurrence rate of calculi between control group and observation group［22.5% (16/71) vs 26.2%(17/65)］(P=0.623). Incidence of complications in observation group was significantly lower than that in control group［27.7%(18/65) vs 60.6%(43/71)］(P=0.001). Multivariate logistic analysis showed that preoperative albumin and intraoperative biliary multi-drug-resistant bacterial infection were independent risk factors of complications after PTCSL in patients with IHS(both P＜0.05). Conclusions    PTCSL is a safe and effective therapeutic choice for IHS. Recurrence rate of cholelithiasis is similar between PTCSL and traditional surgery. Complication rate of PTCSL is low. Preoperative aseptic cleaning and albumin level monitoring are important for lowering complications and improving surgical outcomes.