两种微创手术治疗肝胆管结石的对比研究

Comparative study of clinical efficacy of percutaneous hepatocholangiostomy and laparoscopic choledocholithotomy for primary hepatolithiasis

摘要:

探讨经皮肝胆道造瘘碎石取石术与腹腔镜胆总管切开取石术治疗肝内外胆管结石的可行性及临床疗效。方法回顾性分析61例实施微创手术治疗的肝内外胆管结石患者的临床资料，其中行经皮肝胆道造瘘碎石取石术（PCH）26 例，行腹腔镜胆总管切开取石术（LCC）35 例。结果除4 例因故转开腹手术外，两组患者手术均成功实施，未发生严重并发症。PCH 组术中出血量与LCC 组比较，差异有统计学意义（ p<0.05），PCH组术中出血量少于LCC组。PCH组胃肠功能恢复时间及住院时间与LCC组比较，差异有统计学意义（p <0.05），PCH组胃肠功能恢复时间及住院时间均短于LCC 组。而两组在手术时间、结石一次清除率及并发症发生率比较，差异无统计学意义（p >0.05）。结论PCH 和LCC 治疗肝胆管结石均可行、安全及有效，但在多次腹部手术史后胆管残余结石、复发结石或合并急性梗阻性化脓性胆管炎等患者中，PCH 体现了独特的优势。

Abstract:

To investigate the feasibility and clinical efficacy of percutaneous hepatocholangiostomy(PCH) and laparoscopic choledocholithotomy (LCC) for primary hepatolithiasis. Methods The clinical data of61 cases with hepatolithiasis were retrospectively analyzed. Among the 61 patients. 26 cases underwent PCH and 35 cases underwent LCC. Results Except for 4 cases who underwent laparotomy finally, all the operations were successfully performed without serious complications. The amount of bleeding in the PCH group was significantly smaller than that in the LCC group (p < 0.05). The recovery time for gastrointestinal function and the duration of hospital stay in the PCH group were markedly shorter than those in the LCC group (p < 0.05).There was no significant difference in operation time, stone clearance rate or complication rate between the two groups ( p> 0.05). Conclusions PCH and LCC are feasible, safe and effective for the treatment of hepatolithiasis. But PCH has unique advantages in the patients with abdominal surgery history, residual stones, recurrent stones, or combined with acute obstructive suppurative cholangitis.