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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),1周后用探条扩张此通路至16～22F,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15mm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。
Objective To investigate the value of percutaneous transhepatic cholecystectomy (PTCCS) in the treatment of gallstone. Methods From September 1999 to November 2001, 86 patients with cholecystolithiasis who had clinical symptoms but who had systemic diseases who could not tolerate surgery or were not suitable for laparoscopic cholecystectomy and reluctance to undergo cholecystectomy were treated with PTCG , Percutaneous transhepatic gallbladder drainage (PTGBD) was performed. One week later, this passage was expanded with a probe to 16-22F using PTCCS lithotripsy or electrohydrolitholithography (EHL). Results Of the 86 patients, 82 (95.3%) had successful PTGBD and 80 (93.0%) received PTCCS. 28 cases of single stone, multiple in 52 cases, stone size 5 ~ 32 mm, 45 cases of stones larger than 15mm. Twenty-six cases were enrolled in the basket and 54 cases were EHL. The stone clearance rate was 97.5% (78/80) and the residual stone rate was 2.5% (2/80). 4 patients with peritonitis and 2 cases of drainage tube prolapse did not agree to repeat PTGBD surgery. With an average follow-up of 16.4 months, two patients (2.5%) had recurrent stones. 30 cases of stone quantitative infrared spectroscopy, 24 cases (80%) of cholesterol stones. Conclusion PTCCS treatment of gallstones is a safe and effective method for patients who can not tolerate surgery or are not suitable for laparoscopic cholecystectomy and those who do not undergo cholecystectomy. Correct choice of indications can reduce complications and reduce the recurrence rate of stones.