经皮经肝胆囊镜治疗胆囊结石价值的探讨

目的：探讨经皮经肝胆囊镜（PTCCS）治疗胆囊结石的价值。方法：1999年9月至2001年11月选择有胆囊结石临床症状但有全身疾病不能耐受手术或不适宜腹腔镜胆囊切除及不愿接受胆囊切除的患者86例，行经肝胆囊镜(PTCCS)治疗，先行经皮经肝胆囊引流术(PTGBD)，l周后用探条扩张此通路至16—22 F，采用PTCCS取石或液电碎石(EHL)。结果：86例中82例(95．3％)PTGBD成功，80例(93．0％)行PTCCS治疗。结石单发28例，多发52例，结石大小5—32 mm，大于15 mm的结石45例。26例网篮取石，54例EHL，结石清除率97．5％(78／80)，残石率2．5％(2／80)。4例合并腹膜炎和2例引流管脱出未同意再次PTGBD者转外科手术。平均随访16．4个月，2例(2．5％)结石复发。30例结石做红外线光谱定量分析，24例(80％)为胆固醇结石。结论：PTCCS治疗胆囊结石对不能耐受手术或不适合腹腔镜胆囊切除以及不接受胆囊摘除者是一种较安全、有效的方法。正确选择适应证可减少并发症，降低结石复发率。

Percutaneous transhepatic cholecystoscopy in treating cholecystolithiasis

Objective To evaluate the significance of percutaneous transhepatic cholecystoscopy ( PTCCS) in managing cholecystolitheasis. Methods From September 1999 to November 2001, eighty - six patients with symptomatic gallstones were allocated into this study. At first percutaneous transhepatic gallbladder drainage ( PTGBD) was carried out, one week later the formed fistula was dilated by bouginage to 16-22Fr in diameter, thereafter cholecystoscope was inserted into gallbladder through the dilated fistula to extract the stones using basket or electrohydraulic lithotripsy (EHL). Results PTGBD was attempted successfully in 82 out of 86 cases, PTCCS was performed in 80 of them. The amount of stones ranged from 1 to 76, single stone in 28 patients, stones more than two in 52 , with stone size ranged from 5 to 32 mm, and stones greater than 15mm in 45 cases. The stones were removed only using basket in 28, and by EHL in 54 cases due to their large size. The overall stone removal rate was 97. 5 % (78/80) . Complication of peritonitis appeared in 4 cases (4. 7% ) requiring emergent surgical intervention. The follow - up period with an average of 16. 4 months, gallstones recurred in 2 cases (2.5%). Stones were assayed by intra - red spectrom-etry in 30 of 54 patients with EHL, cholesterol stone existed in 24 of them. Conclusion PTCCS is relatively a safe and effective procedure for those patients with high risk on surgical cholecystectomy, or unsuitable to receive laparoscopic cholecystectomy. If the patients were selected strictly along the rules of indication, the complication and stone recurrence can be avoided.