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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (02) : 250 -255. doi: 10.3877/cma.j.issn.2095-3232.2025037

临床研究

超声引导下经皮肝穿刺胆管取石术在胆道损伤修复术后胆管狭窄中的应用
胡敏1, 黄刚1, 黄蕾芙1, 杨玘霏1, 谭晓雯1, 蔡静雯1, 孙健1,()   
  1. 1. 510630 广州,暨南大学附属第一医院肝胆外科
  • 收稿日期:2024-12-03 出版日期:2025-04-10
  • 通信作者: 孙健
  • 基金资助:
    广东省基础与应用基础研究基金(2022A1515011865,2022A1515012581)广州市校联合基金(2023A03J0598)

Application of ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy in biliary stricture after bile duct injury repair

Min Hu1, Gang Huang1, Leifu Huang1, Qifei Yang1, Xiaowen Tan1, Jingwen Cai1, Jian Sun1,()   

  1. 1. Department of Hepatobiliary Surgery,the First Affiliated Hospital of Jinan University,Guangzhou 510630,China
  • Received:2024-12-03 Published:2025-04-10
  • Corresponding author: Jian Sun
引用本文:

胡敏, 黄刚, 黄蕾芙, 杨玘霏, 谭晓雯, 蔡静雯, 孙健. 超声引导下经皮肝穿刺胆管取石术在胆道损伤修复术后胆管狭窄中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 250-255.

Min Hu, Gang Huang, Leifu Huang, Qifei Yang, Xiaowen Tan, Jingwen Cai, Jian Sun. Application of ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy in biliary stricture after bile duct injury repair[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 250-255.

目的

探讨超声引导下经皮肝穿刺胆管取石术(PTCL)在胆道损伤修复术后胆管狭窄中的应用安全性和疗效。

方法

回顾性分析2021 年7 月至2023 年9 月在暨南大学附属第一医院治疗的4 例胆道损伤修复术后胆管狭窄患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男2 例,女2 例;年龄44~62 岁,中位年龄50 岁。4 例Child-Pugh 分级均为B 级,胆道损伤Strasberg 分型D、E1、E2、E4 型各1 例。患者胆道损伤修复术后胆管狭窄,反复出现胆管炎,采用超声引导下PTCL 治疗,超声引导下穿刺并建立窦道,利用硬质胆道镜取石、放置支架管等。分析该治疗方法对胆道损伤患者的可行性及安全性。

结果

4 例患者均成功实施手术。其中3 例行2 次治疗后拔除胆道引流管,1 例行1 次治疗后留置胆道引流管作为胆道支撑,3 个月后行第二次手术治疗,包括更换引流管、清理修整胆道及取出残余结石。随访时间为3.0~24.0 个月,中位随访时间12.5 个月,随访期间未出现胆管炎表现。

结论

超声引导下PTCL 可作为胆道损伤修复术后胆管狭窄的有效治疗方法之一。

Objective

To evaluate the safety and efficacy of ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy (PTCL) in the treatment of biliary stricture after bile duct injury repair.

Methods

Clinical data of 4 patients with biliary stricture after biliary tract injury repair admitted to the First Affiliated Hospital of Jinan University from July 2021 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 2 patients were male and 2 female, aged from 44 to 62 years, with a median age of 50 years.The liver function of 4 patients was graded as Child-Pugh B.The bile duct injury was graded as Strasberg D,E1, E2 and E4, respectively.Patients experienced biliary stricture and recurrent cholangitis after biliary tract injury repair.Ultrasound-guided PTCL was adopted.Ultrasound-guided puncture was performed to establish sinus tract.Stone removal was performed by rigid choledochoscopy and stent placement was conducted.The feasibility and safety of this procedure for patients with biliary tract injury were evaluated.

Results

4 patients successfully completed the operation.Among them, biliary drainage catheter was removed after 2 cycles of treatment in 3 patients.In 1 patient, biliary drainage catheter was maintained to support the biliary duct after 1 cycle of treatment.At 3 months later, secondary operation was performed including drainage catheter replacement, biliary tract repair and residual stone removal.The follow-up time was 3.0-24.0 months, with a median follow-up time of 12.5 months.No cholangitis was reported during postoperative follow-up.

Conclusions

Ultrasound-guided PTCL can be used as one of the efficacious interventions for biliary stricture after bile duct injury repair.

表1 四例胆道损伤患者手术经历、胆道损伤分型
图1 例3 胆道损伤修复术后胆管狭窄患者第一次手术前影像学检查 注:a、b 为第1 次术前超声影像,示肝右叶肝内胆管见两个强回声团,较大者约5 mm×7 mm,后伴声影(红色箭头所示), 胆总管内引流管留置(绿色箭头所示);c 为CT 示肝内胆管稍扩张积气,肝内胆管结石(蓝色箭头所示)
图2 例3 胆道损伤修复术后胆管狭窄患者第二次手术前影像学检查 注:a、b 为第2 次术前超声影像,示肝右叶肝内胆管可见管道回声(红色箭头所示),肝内胆管可见多个稍强回声团(绿色箭头所示),较大者约4 mm×7 mm;c 为CT 示胆总管及肝内胆管扩张较前明显,肝内胆管结石及积气较前减少、吸收(蓝色箭头所示)
图3 例3 胆道损伤修复术后胆管狭窄患者第一次术中胆道镜观察肝内胆道情况 注:a 为扩张肝内瘘管后进入胆道,示肝内胆管狭窄;b 示狭窄胆管周围炎性息肉;c 示肝内胆道结石;d 示应用网篮扩张胆道内的炎性狭窄;e 示异物钳钳夹胆管内炎性组织;f 示扩张及修整后的胆管狭窄部位
图4 例3 胆道损伤修复术后胆管狭窄患者第二次术中胆道镜观察肝内胆道情况 注:a 为循导丝进入胆道;b 示再次观察狭窄胆管,较前增大;c 示应用异物钳轻微扩张周围胆道;d 示应用电刀电切狭窄胆管右侧壁;e 示应用电刀电切狭窄胆管左侧壁;f 为应用网篮再次扩张狭窄口
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