经皮经肝内镜联合不同碎石方式精准治疗复杂肝胆管结石：附49例报告

目的:探讨经皮经肝内镜(PTES)联合不同碎石方式精准治疗复杂肝胆管结石的效果并总结相关经验。方法:回顾性分析49例行PTES结合钬激光或液电碎石治疗的复杂肝胆管结石患者临床资料。结果:手术成功率93.9%(46/49);平均手术时间与出血量(107.5±8.9)min、(43.6±10.4)mL,残石率8.7%(4/46),并发症发生18例次;结石近期复发率6.5%,远期复发率13.6%。结论:PTES结合不同碎石方式精准治疗复杂肝胆管结石显示出了良好效果,对于无肝叶萎缩,结石局限于段/叶者,以及有多次胆道手术史,无法耐受开腹手术患者推荐首选此方法治疗。

Percutaneous transhepatic endoscopy combined with different lithotripsy methods for precision treatment of complicated hepatolithiasis: a report of 49 cases

Objective: To investigate clinical efficacy of percutaneous transhepatic endoscopy (PTES) combined with different lithotripsy methods for precision treatment of complicated hepatolithiasis and summarize relevant experiences. Methods: The clinical data of 49 patients with complicated hepatolithiasis undergoing PTES plus holmium laser lithotripsy or electrohydraulic lithotripsy were retrospectively analyzed. Results: The surgical successful rate was 93.9% (46/49). The average operative time was (107.5±8.9) min and blood loss was (43.6±10.4) mL. The incidence of residual stones was 8.7% (4/46) and complications occurred 18 times. The short- and long-term recurrence rate was 6.5% and 13.6%, respectively. Conclusion: PTES combined with different lithotripsy methods shows favorable efficacy in precision treatment of complicated hepatolithiasis. This method is recommended as the first choice of options for patients with no lobar atrophy, and the stones confined to one segment or one lobe of the liver as well as those without tolerance to an open surgery due to repeated biliary operation history.