超声结合X线指导原发性肝内胆管结石患者手术的价值

目的超声结合X线对原发性肝内胆管结石（PHL）患者经皮肝胆穿刺引流术（PTCD）治疗的指导作用和临床效果。方法选取2017年6月~2019年6月我院114例PHL患者为研究对象，采用随机数字表法将患者分为联合组和X线组，57例/组，联合组B超结合X线引导下进行PTCD治疗，X线组仅在C臂X线透视下实施PTCD，比较两组围术期情况、治疗效果、肝功能、复发情况和并发症。结果联合组手术时间、穿刺次数、术中出血量、胃肠蠕动恢复时间及住院时间少于X线组（P < 0.05）；联合组和X线组手术成功率分别为98.15%、90.38%，差异无统计学意义（P>0.05），结石残留率分别为5.56%、19.23%，差异有统计学意义（P < 0.05）；术后第3天两组血清总胆红素、谷丙转氨酶及淀粉酶水平明显升高（P < 0.05），且联合组血清总胆红素、谷丙转氨酶及淀粉酶水平低于X线组，差异有统计学意义（P < 0.05）；术后3年复发率分别为12.96%、0.77%（P < 0.05）；两组并发症发生率分别为14.81%、2.69%（P < 0.05）。结论B超结合X线指导PHL患者PTCD治疗可增加定位和穿刺准确性，提升结石清除效果并减轻肝组织结构和功能损伤，减轻机体炎症反应，减少术后并发症发生。 

Value of ultrasound combined with X-ray on surgical treatment of patients with primary hepatolithiasis

ObjectiveTo explore the guiding and clinical effects of ultrasound combined with X-ray on percutaneous transhepatic cholangial drainage (PTCD) in patients with primary hepatolithiasis (PHL).MethodsA total of 114 patients with PHL in our hospital from June 2017 to June 2019 were selected. They were divided into combined group and X-ray group according to the random number table method, with 57 cases in each group. Combined group was given PTCD treatment under B-ultrasound combined with X-ray guidance, and X-ray group was given PTCD only under C-shaped arm X-ray perspective.The perioperative conditions, treatment effects, liver function, recurrence and complications were compared between the two groups.ResultsThe operative time, puncture frequency, intraoperative blood loss, recovery time of gastrointestinal peristalsis and hospital stay in combined group were significantly less than those in X-ray group (P < 0.05). The success rates of surgery in combined group and X-ray group were 98.15% and 90.38% respectively (P>0.05). The residual stone rates were 5.56% and 19.23% (P < 0.05). On the 3rd day after operation, the levels of serum TBIL, ALT and amylase were significantly increased in the two groups (P < 0.05). The levels of serum TBIL, ALT and amylase in combined group were lower than those in X-ray group (P < 0.05). The recurrence rates at 3 years after operation were 12.96 % and 30.77% (P < 0.05).The incidence rates of complications in two groups were 14.81% and 32.69%, respectively (P < 0.05).ConclusionPTCD treatment guided by B-ultrasound combined with X-ray for PHL patients can improve the accuracy of localization and puncture, enhance the stone removal effects and reduce the structural and functional damage of liver tissue. It can relieve the body inflammatory response and reduce occurrence of postoperative complications.