CAJ | 학술논문

目的探讨与评价经皮经肝胆道镜(percutaneous transhepatic choledochoscope,PTCS)、经皮肾镜(percutaneous nephroscope,PCN)联合超声碎石清石系统经胆道造瘘窦道治疗高龄患者肝内外胆管结石的安全性与疗效.方法回顾性分析70岁以上高龄肝内外胆管结石患者23例,其中胆囊切除术后胆总管结石复发18例、胆总管结石合并肝内胆管结石5例,均经皮经肝穿刺造瘘窦道取石.结果手术均成功,单次治疗结石取尽率为87％,3例残留结石,二次手术完全取尽.平均手术时间(118 ±43) min,术中平均失血(16±17.3) ml,无重症胆管炎等严重并发症,随访3～26个月,未见结石残留、复发、胆管狭窄及其他严重并发症.结论对于胆石症术后残留胆管结石患者,胆道镜、经皮肾镜联合超声碎石清石系统经造瘘窦道治疗肝内外胆管结石效率高、严重并发症少,是一种安全有效的治疗方法.
목적 탐토여평개경피경간담도경(percutaneous transhepatic choledochoscope,PTCS)、경피신경(percutaneous nephroscope,PCN)연합초성쇄석청석계통경담도조루두도치료고령환자간내외담관결석적안전성여료효.방법 회고성분석70세이상고령간내외담관결석환자23례,기중담낭절제술후담총관결석복발18례、담총관결석합병간내담관결석5례,균경피경간천자조루두도취석.결과 수술균성공,단차치료결석취진솔위87％,3례잔류결석,이차수술완전취진.평균수술시간(118 ±43) min,술중평균실혈(16±17.3) ml,무중증담관염등엄중병발증,수방3～26개월,미견결석잔류、복발、담관협착급기타엄중병발증.결론 대우담석증술후잔류담관결석환자,담도경、경피신경연합초성쇄석청석계통경조루두도치료간내외담관결석효솔고、엄중병발증소,시일충안전유효적치료방법.
Objective To investigate the therapeutic effect and complications of PTCS and PCN combined with ultrasonic lithotripsy in the treatment of intra-and extrahepatic bile duct stones in elderly age ＞ 70 and poor risk patients.Methods Twenty three elderly patients with choledocholithiasis were enrolled,including post-cholecystectomy 18 cases with choledocholithiasis,intra-and extrahepatic bile duct calculus in 5 cases.After establishment of percutaneous transhepatic fistula,stones were removed in operating theatre under anesthesia.Results All operations were successful.The clearance rate of calculus after first round of therapy was up to 87％.The mean operation time was (118 ± 43) min,blood loss was (16 ± 17.3) ml,there was not serious complications such as massive bleeding and severe cholangitis.After 3-26 months following up,there was no postoperative serious complications as residual and recurrence of calculus and no biliary stricture.Conclusions For postoperative remaining bile duct stones in elderly patients,PTCS and PCN combined with ultrasonic lithotripsy is effective and safe for stones clearance.