顺逆结合治疗胆总管结石合并肝胆管结石的临床分析

目的探讨经十二指肠镜逆行取石(ERCP)与经皮肝胆道镜顺行取石(PTCS)联合治疗胆总管结石合并肝胆管结石的疗效。方法对25例胆总管结石合并肝胆管结石患者行ERCP+PTCS治疗,即在ERCP治疗胆总管结石后即可行经皮肝穿刺胆道造瘘术,术后5～7天行经瘘道胆道镜取石术。总结临床资料,并与同期27例行胆总管切开胆道镜探查取石治疗的患者资料对比分析。结果 ERCP与PTCS术联合治疗胆总管结石合并肝内胆管结石25例,结石取净率为96.0%,优于对照组的70.4%(P<0.05);并发症发生率相当,住院时间较短,花费相对较多(P<0.01)。结论 ERCP联合PTCS是治疗胆总管结石合并肝胆管结石的安全有效的方法。

Clinical Analysis of the Combination of Retrograde and Antegrade Access Endoscopy for Treatment of Common Bile Duct Stones Complicated with Hepatolithiasis

Objective To discuss the effect of encoscopic retrograde cholangio-pancreatogra （ERCP） and percutaneous transhepatic cholangioscopy （PTCS） in the treatment of choledocholithiasis complicated with hepatolithiasis. Methods 25 patients with choledocholithiasis and hepatolithiasis were treated with ERCP＋PTCS （patients received percutaneous transhepatic gastrostomy after ERCP treatment of common bile duct stones, and were treat with fistula choledochofiberscopy 5-7 days after the first surgical operation）. The clinical data were compared with 27 patients treated with choledochotomy choledochoscopic lithotomy. Results Among 25 cases of choledocholithiasis and hepatolithiasis treated with ERCP＋PTCS, the stone clearance rate was 96.0%, better than 70.4%of control group （P〈0.05）, with similar complication rate, shorter length of hospital stay and relatively high costs （P 〉0.05）. Conclusions The combination therapy of ERCP and PTCS is a safe and effective way to treat choledocholithiasis and hepatolithiasis.