Research on percutaneous transhepatic choledochoscopic lithotomy in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope
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摘要:目的 探讨新型光纤胆道镜(SFCS)引导下经皮肝穿刺胆道镜取石术(PTCSL)治疗肝内胆管结石的效果。方法 选取行PTCSL的患者129例，其中行常规PTCSL患者57例，行SFCS引导下PTCSL患者72例。根据治疗方法的不同将患者分为SFCS组(n=72)和常规组(n=57)。采用倾向评分匹配法对2组患者的基线指标进行平衡，匹配后2组分别有51例患者。比较2组患者手术时间、出血量、术后肠鸣音恢复时间、排便时间、术后住院时间及结石复发率。结果 SFCS组术中出血量少于常规组，手术时间、术后住院时间、术后肠鸣音恢复时间以及排便时间均短于常规组，差异有统计学意义(P < 0.05)。SFCS组术后复发率低于常规组。结论 新型SFCS具有视野清晰、镜身纤细、镜头灵活、操作方便、可联合冷激光碎石设备等优点, SFCS引导下PTCSL应用于肝内胆管结石患者的治疗安全有效。
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关键词:
- 光纤胆道镜 /
- 肝内胆管结石 /
- 经皮肝穿刺胆道镜取石术 /
- 复发率
Abstract:Objective To investigate the effect of percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in treatment of hepatolithiasis guided by soft fiber-optic choledochoscope (SFCS).Methods A total of 129 patients with PTCSL were selected, including 57 patients with conventional PTCSL and 72 patients with PTCSL guided by SFCS. Patients were divided into SFCS group (n=72) and conventional group (n=57) according to differed treatment methods. Propensity score matching method was used to balance the baseline indicators of patients in the two groups. After matching, there were 51 patients in each group. Operation time, blood loss, postoperative bowel sound recovery time, defecation time, postoperative hospital stay and stone recurrence rate were compared between the two groups.Results The amount of intraoperative blood loss in the SFCS group was significantly less, the operation time, postoperative hospital stay, postoperative bowel sound recovery time and defecation time were significantly shorter than those in the conventional group (P < 0.05). The postoperative recurrence rate of the SFCS group was lower than that of the conventional group.Conclusion The new SFCS has the advantages of clear field of vision, slim lens, flexible lens as well as convenient operation, and it can be combined with cold laser lithotripzer. PTCSL guided by SFCS is safe and effective in the treatment of patients with hepatolithiasis. -
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表 1 2组匹配前后患者的基线特征[n(%)](x±s)
基线特征 匹配前 匹配后 SFCS组(n=72) 常规组(n=57) P值 SFCS组(n=72) 常规组(n=57) P值 年龄/岁 75.4±6.5 82.8±5.1 < 0.01 76.6±8.2 76.5±9.3 0.03 性别 男 38(52.8) 31(54.4) < 0.01 26(51.0) 26(51.0) > 0.99 女 34(47.2) 26(45.6) - 25(49.0) 25(49.0) - 胆总管直径 ≥0.8 cm 40(55.6) 33(57.9) < 0.01 28(54.9) 28(54.9) > 0.99 < 0.8 cm 32(44.4) 24(42.1) - 23(45.1) 23(45.1) - 结石数目 ≥3个 39(54.2) 32(54.1) < 0.01 27(52.9) 27(52.9) > 0.99 < 3个 33(45.8) 25(45.9) - 24(47.1) 24(47.1) - 黄疸 有 41(56.9) 33(57.9) < 0.01 25(49.0) 25(49.0) > 0.99 无 31(43.1) 24(42.1) - 26(51.0) 26(51.0) - 
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表 2 2组在倾向匹配后的手术结果(x±s)
指标 SFCS组(n=51) 常规组(n=51) 手术时间/min 120.4±5.6* 152.3±5.8 失血量/mL 52.0±6.8* 80.2±7.2 复发率/% 0 3.9 住院时间/d 3.2±0.8* 5.2±0.9 术后肠鸣音恢复时间/d 1.2±0.5* 1.8±0.9 排便时间/d 2.3±0.4* 3.0±0.3 与常规组比较, *P < 0.05。
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