一期缝合胆道中经皮经肝穿刺胆道引流术的应用价值分析

doi:10.3969/j.issn.1005-6483.2020.08.012

摘要/Abstract

摘要： 目的观察一期缝合胆道中经皮经肝穿刺胆道引流术（PTCD）的应用价值。
方法胆囊结石伴胆总管结石病人60例，PTCD组30例，行PTCD和腹腔镜胆道探查术，对照组30例，行腹腔镜胆道探查术。PTCD组在对照组的基础上于术前接受PTCD且术后经PTCD减压引流3～6天。比较两组病人手术指标、术后恢复情况、并发症发生情况、疼痛程度（VAS评分）、1年内结石复发率。
结果 PTCD组腹腔镜手术时间短于对照组，术中出血量低于对照组（P＜0.05）。两组均顺利完成手术，无中转开腹者。两组术后结石残留率比较差异无统计学意义（P>0.05）。术后12小时，PTCD组VAS评分为（3.9±1.0）分，对照组为（3.8±1.1）分，差异无统计学意义（P>0.05）。PTCD组住院时间、引流管拔除时间、术后排气时间均较对照组短，差异有统计学意义（P＜0.05）。两组术后肺部感染、胆道感染、胆管内出血、胆汁漏发生率及总并发症发生率比较差异无统计学意义（P>0.05）。PTCD组失访1例，对照组失访2例，随访1年，PTCD组胆总管结石复发1例，对照组复发1例，两组复发率分别为3.45%和3.57%，差异无统计学意义P>0.05）。
结论对于年龄>65岁、胆总管直径≥1.0cm的高龄胆囊结石伴胆总管结石病人，PTCD可缩短手术时间，降低组织损伤，促进术后恢复。

关键词: 经皮经肝穿刺胆道引流术, 腹腔镜胆道探查术, 胆囊结石, 胆总管结石

Abstract: Objective To observe the effect of percutaneous transhepatic biliary drainage（PTCD）in elderly patients with cholecystolithiasis and common bile duct stones undergoing laparoscopic biliary exploration.
Methods Cholecystolithiasis with choledocholithiasis in 60 cases，30 cases of elderly patients with cholecystolithiasis and common bile duct stones who underwent PTCD and laparoscopic cholecystectomy who were treated in the Hepatobiliary and Pancreatic Surgery of the First People's Hospital of Suqian City were selected as the PTCD group.At the same time，30 elderly cholecystolithiasis patients undergoing laparoscopic choledocholithotomy patients with common bile duct stones served as the control group.On the basis of the control group，the PTCD group received PTCD before surgery and was decompressed and drained for 3～6 days after surgery.The surgical indicators，postoperative recovery，complications，pain（VAS score），and recurrence rate of stones within 1 year were compared between the two groups.
Results The laparoscopic operation time in the PTCD group was shorter than that in the control group，and the intraoperative blood loss was lower than that in the control group（P<0.05）.Both groups successfully completed the operation without conversion to open surgery.There was no significant difference in the residual stone rate between the two groups after surgery（P> 0.05）.At 12 hours after operation，the VAS score of the PTCD group was（3.9±1.0）and had no significant difference with the control group（3.8±1.1）（P> 0.05）.The hospitalization time，drainage tube removal time，and postoperative exhaust time in the PTCD group were shorter than those in the control group，and the differences were statistically significant（P<0.05）.There was no significant difference in the incidence of pulmonary infection，biliary tract infection，bile duct hemorrhage，bile leakage，and total complications between the two groups（P>0.05）.One case was lost to follow-up in the PTCD group，2 cases were lost to follow-up in the control group，and 1 year was followed up.There was a statistically significant difference in recurrence rates between the two groups（3.45% vs.3.57%，P>0.05）.
Conclusion For older patients > 65 years old and common bile duct diameter ≥1.0cm with choledocholithiasis and common bile duct stones，PTCD 〖LM〗can shorten the operation time，reduce tissue damage and promote postoperative recovery.

Key words: percutaneous transhepatic biliary drainage, laparoscopic bile duct exploration, gallbladder stones, common bile duct stones

王永朱小朝朱红岩胡建平黄茂盛李勇庄文龙. 一期缝合胆道中经皮经肝穿刺胆道引流术的应用价值分析[J]. 临床外科杂志, 2020, 28(8): 736-739.

WANG Yong, ZHU Xiaochao, ZHU Hongyan, et al.. Effect of PTCD in elderly patients with cholecystolithiasis and common bile duct stones undergoing laparoscopic bile duct exploration[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(8): 736-739.

参考文献

相关文章 15

[1]	雷婷李茜蒋丽丽孙金山张建红刘萍聂占国. 内镜下乳头括约肌小切开联合球囊扩张术治疗胆总管结石合并十二指肠乳头旁憩室的疗效及对病人血清胆红素水平的影响[J]. 临床外科杂志, 2020, 28(4): 358-360.
[2]	杜京丽, 郭庆森, 郑茂煌, 刘益峰, 吴德柱. 微创胆总管切开取石不同手术方式的疗效对比研究[J]. 临床外科杂志, 2019, 27(8): 664-667.
[3]	胡水根, 朱婷婷, 徐小平等. 胆道镜或ERCP联合腹腔镜治疗胆囊结石合并胆总管结石的临床体会[J]. 临床外科杂志, 2019, 27(7): 620-621.
[4]	郑兵, 王伟, 任锐, 朱涛, 芦灵军, 陆昌友. 胆总管结石病人腹腔镜胆囊切除术联合内镜括约肌切开术术后并发症及其影响因素分析[J]. 临床外科杂志, 2019, 27(6): 485-488.
[5]	徐降兴, 肖义容, 杨小红, 石铮. MRCP诊治胆囊结石合并正常范围直径胆总管结石中的应用价值及有效性分析[J]. 临床外科杂志, 2019, 27(3): 250-252.
[6]	巴雅尔, 李钢, 高洪强, 卢晖, 张荣. 经脐单孔腹腔镜胆囊切除术与传统腔镜胆囊切除术的比较分析[J]. 临床外科杂志, 2019, 27(2): 155-157.
[7]	张荣广刘成菊. 不同微创保胆取石术的临床疗效对胆囊结石病人胆囊、肝功能及生活质量的影响[J]. 临床外科杂志, 2018, 26(9): 696-698.
[8]	台剑熊许丙辉李恒力齐双玉. 胆囊结石病人胆囊组织Cajal间质细胞数目变化及其收缩功能的相关性研究[J]. 临床外科杂志, 2018, 26(11): 865-867.
[9]	李志庆孙吉霞李斌李哲夫. 全内脏反位胆囊结石行腹腔镜胆囊切除术一例[J]. 临床外科杂志, 2018, 26(11): 892-892.
[10]	徐新保;张洪义;张辉等. 腹腔镜保胆取石术65例体会[J]. 临床外科杂志, 2012, 20(8): 548-550.
[11]	李进军;伍冀湘;梁杰雄. 腹腔镜胆囊切除辅助小切口胆总管探查治疗胆囊结石合并胆总管结石的临床研究[J]. 临床外科杂志, 2012, 20(8): 551-553.
[12]	朱自满郑慧清许勇王大东焦华波. 胆囊结石并发源性重症急性胰腺炎行腹腔镜胆囊切除术手术时机的探讨[J]. 临床外科杂志, 2012, 20(2): 92-92.
[13]	刘家盛. 胆总管探查后一期缝合并术中置胆道内支架引流术28例[J]. 临床外科杂志, 2011, 19(8): 580-580.
[14]	高志强李建文蔡宏俊徐冬青龚建华李冰. 糖尿病患者行腹腔镜及开腹胆囊切除术[J]. 临床外科杂志, 2011, 19(12): 815-815.
[15]	范平丁佑铭汪斌陈晓燕余莉. 高胆固醇饮食对妊娠豚鼠胆囊AQPs mRNA及雌性激素受体的影响[J]. 临床外科杂志, 2011, 19(12): 826-826.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed