经皮经胆囊十二指肠乳头肌扩张排石术治疗胆总管结石的可行性及安全性

目的探讨经皮经胆囊十二指肠乳头肌扩张排石术治疗胆总管结石的可行性及安全性。方法2017年1月至2019年1月,选择我院接受经皮经胆囊十二指肠乳头肌扩张排石术(观察组)与内镜乳头切开取石术(对照组)的胆总管结石患者各50例。比较两组的手术情况、临床疗效、结石排净率、术后并发症发生情况、胆囊功能指标、复发率及生活质量评分。结果两组的手术时间、术中出血量、治疗总有效率、结石排净率、术后并发症发生率比较,差异均无统计学意义(P>0.05),但观察组的术后6个月空腹胆囊容积、餐后胆囊排出量大于对照组,各项生活质量评分高于对照组,复发率低于对照组(P<0.05)。结论经皮经胆囊十二指肠乳头肌扩张排石术用于胆总管结石治疗中不仅可达到与内镜乳头切开取石术相当的近期疗效和安全性,还具有保留胆囊功能、术后复发少等优势,有利于提高患者的生活质量。

Feasibility and safety of percutaneous dilatational lithotripsy of papillary muscle of gallbladder and duodenum on choledocholithiasis

Objective To explore the feasibility and safety of percutaneous dilatational lithotripsy of papillary muscle of gallbladder and duodenum on choledocholithiasis.Methods From January 2017 to January 2019,the patients with choledocholithiasis who received percutaneous dilatational lithotripsy of papillary muscle of gallbladder and duodenum(observation group)and endoscopic papillotomy and lithotomy(control group)were selected from our hospital,with 50 cases in each group.The operation status,clinical efficacy,calculi clearance rates,postoperative complications,gallbladder function indexes,recurrence rates and quality of life scores of the two groups were compared.Results There were no statistically significant differences in operation time,intraoperative bleeding volume,total effective rates of treatment,calculi clearance rates and the incidences of postoperative complications between the two groups(P>0.05),but 6 months after operation,the postoperative fasting gallbladder volume and postprandial gallbladder discharge amount in the observation group were greater than those in the control group,the quality of life scores were higher than those in the control group,the recurrence rate was lower than that in the control group(P<0.05).Conclusion Percutaneous dilatational lithotripsy of papillary muscle of gallbladder and duodenum on choledocholithiasis can not only achieve the short-term effect and safety comparable to endoscopic papillotomy and lithotomy,but also has the advantages of preserving gallbladder function and less postoperative recurrence,which is conducive to improving the life quality of patients.