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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (01) : 87 -90. doi: 10.3877/cma.j.issn.2095-3232.2023.01.017

临床研究

人工控制性胆道加压注水在复杂肝胆管结石经皮经肝胆道镜取石术中的应用
李嘉1,†(), 李雄2   
  1. 1. 514031　广东省梅州市人民医院肝胆外科
    2. 514031　广东省梅州市人民医院超声科
  • 收稿日期:2022-11-08 出版日期:2023-02-10
  • 通信作者: 李嘉
  • 基金资助:
    广东省医学科研基金项目(B2021327)

Application of maneuverable high-pressure water injection into bile duct during percutaneous transhepatic cholangioscopic lithotripsy for complicated hepatolithiasis

Jia Li1,†(), Xiong Li2   

  1. 1. Department of Hepatobiliary Surgery, Meizhou People's Hospital, Meizhou 514031, China
    2. Department of Ultrasound, Meizhou People's Hospital, Meizhou 514031, China
  • Received:2022-11-08 Published:2023-02-10
  • Corresponding author: Jia Li
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李嘉, 李雄. 人工控制性胆道加压注水在复杂肝胆管结石经皮经肝胆道镜取石术中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(01): 87-90.

Jia Li, Xiong Li. Application of maneuverable high-pressure water injection into bile duct during percutaneous transhepatic cholangioscopic lithotripsy for complicated hepatolithiasis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(01): 87-90.

目的

探讨人工控制性胆道加压注水在经皮经肝胆道镜取石术（PTCSL）治疗复杂肝胆管结石中的应用价值。

方法

回顾性分析2014年8月至2021年9月在梅州市人民医院诊治的11例复杂肝胆管结石患者临床资料。其中男6例，女5例；平均年龄（61±9）岁。胆总管结石合并左、右肝管结石3例，胆总管结石合并右肝管结石2例，胆总管结石合并左肝管结石1例，左、右肝管结石3例，右肝管结石1例，胆总管结石1例。患者均签署知情同意书，符合医学伦理学规定。患者行PTCD引出感染性胆汁1周后，建立人工控制性胆道加压注水，使肝内胆管扩张，采用PTCSL取石。观察患者胆道穿刺造瘘成功率、结石清除率、围手术期情况以及术后并发症发生情况。

结果

患者均顺利完成手术，PTCD胆道穿刺平均造瘘时间（15±3）min，穿刺造瘘成功率100%（11/11），手术时间（130±27）min，术中出血量（15±14）ml，总住院时间（22±13）d，术后无腹腔出血、胆漏等并发症发生，结石清除率91%（10/11）。

结论

对于复杂肝胆管结石患者，利用人工控制性胆道加压注水的方法建立经皮经肝取石通道是一种安全、可行的方法。

关键词: 胆结石, 胆道镜, 经皮经肝胆道镜取石, 胆道加压注水
Objective

To evaluate the application value of maneuverable high-pressure water injection into the bile duct in percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for complicated hepatolithiasis.

Methods

Clinical data of 11 patients with complicated hepatolithiasis admitted to Meizhou People's Hospital from August 2014 to September 2021 were retrospectively analyzed. Among them, 6 patients were male and 5 female, aged (61±9) years on average. 3 cases of choledocholithiasis were complicated with the left and right hepatic duct stones, 2 cases of choledocholithiasis complicated with the right hepatic duct stones,1 case of choledocholithiasis complicated with the left hepatic duct stone, 3 cases of the left and right hepatic duct stones, 1 case of the right hepatic duct stone and 1 case of choledocholithiasis, respectively. The informed consents of all patients were obtained and the local ethical committee approval was received. After 1-week drainage of bile by percutaneous transhepatic cholangiodrainage (PTCD), maneuverable high-pressure water injection into the bile duct was performed to dilate the intrahepatic bile duct, and biliary stones were removed by PTCSL. The success rate of biliary tract puncture and fistulization, stone removal rate, perioperative conditions and postoperative complications were observed.

Results

All patients successfully completed the surgery. The average fistulization time during PTCD-guided bile duct puncture was (15±3) min, the success rate of puncture and fistulization was 100%(11/11), the operation time was (130±27) min, intraoperative blood loss was (15±14) ml, and the total length of hospital stay was (22±13) d.No abdominal hemorrhage or biliary leakage occurred after surgery. The stone clearance rate was 91%(10/11).

Conclusions

For patients with complicated hepatolithiasis, it is a safe and feasible approach to establisha PTCSL route by maneuverable high-pressure water injection into the bile duct.

Key words: Cholelithiasis, Choledochoscope, Percutaneous transhepatic cholangioscopy, Biliary pressurized injection
图1 复杂肝内胆管结石患者行PTCD人工控制性胆道加压注水建立取石通道过程 注：a为超声示胆道穿刺前肝内胆管轻度扩张；b示穿刺引流后胆道无扩张，置入鞘管困难；c、d示人工控制性胆道加压注水后肝内胆道扩张；e为测压传感器；f为实时读取胆道压力值
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