经皮经肝胆道镜一步取石术治疗胆总管结石。
One-step percutaneous transhepatic cholangioscopic lithotripsy in patients with choledocholithiasis.
机构信息
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, 510120 Guangdong Province, China.
The Hepatic Surgery Centre, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, China.
出版信息
Clin Res Hepatol Gastroenterol. 2021 Mar;45(2):101477. doi: 10.1016/j.clinre.2020.06.003. Epub 2021 Mar 18.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) may be inappropriate for most patients with choledocholithiasis. This study aimed to evaluate one-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) in the treatment of patients with choledocholithiasis who could not undergo ERCP (e.g., failed ERCP, altered anatomy, and/or contra-indications).
METHOD
This was a retrospective single-centre series of 67 patients who underwent choledocholithiasis between November 2015 and March 2018: 35 with one-step PTCSL (Group A) and 32 with laparoscopic common bile duct (CBD) exploration (Group B).
RESULTS
Compared with Group B, Group A showed shorter duration of operation, length of stay in the hospital, postoperative hospital stay, postoperative drainage time, and time to oral intake (all P<0.05). Intraoperative blood loss, costs, conversion to open surgery (one in group A vs. seven in group B; P=0.023), and bile leakage (none in group A vs. four in group B; P=0.047) were lower in Group A than in Group B. There were no significant differences between the two groups regarding the intraoperative clearance rate, ultimate clearance rate, and several postoperative complications.
CONCLUSION
One-step PTCSL could be an alternative for patients with choledocholithiasis, especially when ERCP is not feasible.
背景
内镜逆行胰胆管造影术（ERCP）可能不适合大多数胆石症患者。本研究旨在评估经皮经肝胆道镜碎石术（PTCSL）在不能行 ERCP 治疗的胆石症患者（如 ERCP 失败、解剖结构改变和/或禁忌证）中的应用。
方法
这是一项回顾性单中心系列研究，纳入了 2015 年 11 月至 2018 年 3 月期间 67 例胆石症患者：35 例行一步法 PTCSL（A 组），32 例行腹腔镜胆总管探查术（B 组）。
结果
与 B 组相比，A 组手术时间、住院时间、术后住院时间、术后引流时间和开始口服时间更短（均 P<0.05）。术中出血量、费用、中转开腹手术（A 组 1 例 vs. B 组 7 例；P=0.023）和胆漏（A 组无 vs. B 组 4 例；P=0.047）更少。两组的术中结石清除率、最终结石清除率和几种术后并发症无显著差异。
结论
一步法 PTCSL 可能是胆石症患者的一种替代治疗方法，尤其是在 ERCP 不可行时。
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