超声引导下经皮经肝Ⅰ期胆道造瘘取石术与经皮经肝胆道镜治疗复杂肝胆管结石的结石清除效果及复发率比较

doi:10.3877/cma.j.issn.2095-2015.2026.01.011

中华消化病与影像杂志(电子版) ›› 2026, Vol. 16 ›› Issue (01) : 61 -66. doi: 10.3877/cma.j.issn.2095-2015.2026.01.011

论著

超声引导下经皮经肝Ⅰ期胆道造瘘取石术与经皮经肝胆道镜治疗复杂肝胆管结石的结石清除效果及复发率比较

杨健康¹, 周茂旭², 胡强², 何宗国², 顾亚奇¹^,^†(

)

¹232052　安徽淮南，安徽理工大学附属新华医院普外科
²232052　安徽淮南，安徽理工大学附属新华医院肝胆胰外科

收稿日期:2025-06-09 出版日期:2026-02-01
通信作者: 顾亚奇

Comparative analysis of stone clearance effect and recurrence rate between ultrasound-guided percutaneous transhepatic one-stage biliary fistulization and percutaneous transhepatic cholangioscopy in patients with complex hepatobiliary stones

Jiankang Yang¹, Maoxu Zhou², Qiang Hu², Zongguo He², Yaqi Gu¹^,^†()

¹Department of General Surgery, Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232052, China
²Department of Hepatobiliary and Pancreatic Surgery, Xinhua Hospital Affiliated to Anhui University of Science and Technology, Huainan 232052, China

Received:2025-06-09 Published:2026-02-01
Corresponding author: Yaqi Gu

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引用本文：

杨健康, 周茂旭, 胡强, 何宗国, 顾亚奇. 超声引导下经皮经肝Ⅰ期胆道造瘘取石术与经皮经肝胆道镜治疗复杂肝胆管结石的结石清除效果及复发率比较[J/OL]. 中华消化病与影像杂志(电子版), 2026, 16(01): 61-66.

Jiankang Yang, Maoxu Zhou, Qiang Hu, Zongguo He, Yaqi Gu. Comparative analysis of stone clearance effect and recurrence rate between ultrasound-guided percutaneous transhepatic one-stage biliary fistulization and percutaneous transhepatic cholangioscopy in patients with complex hepatobiliary stones[J/OL]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(01): 61-66.

目的

比较复杂肝胆管结石患者应用超声引导下经皮经肝Ⅰ期胆道造瘘（PTOBF）取石术与经皮经肝胆道镜（PTCS）取石对患者结石清除效果及复发率的影响。

方法

选取2021年1月至2023年1月安徽理工大学附属新华医院收治的104例复杂肝胆管结石患者，回顾性分析临床资料，以不同手术方式分组，对照组50例行PTCS取石，研究组54例行超声引导下PTOBF取石，对比两组围手术期指标、结石清除效果、免疫功能、应激反应、肝功能、并发症及复发率。

结果

研究组术后排气和排便时间较对照组更短（P<0.05）；研究组术中出血量、取石次数较对照组更少（P<0.05）；研究组结石取净率高于对照组（85.19%比68.00%，χ²=4.319，P=0.037）；两组术后1 d、3 d皮质醇（Cor）、肾上腺素（E）及去甲肾上腺素（NE）水平较同组术前均提高，同组术后3 d较1 d的Cor、E及NE水平更低（P<0.05）；两组术后1个月天门冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）水平较同组术前均降低，且研究组降低更明显（P<0.05）；术后1 d研究组CD3⁺、CD4⁺及CD4⁺/CD8⁺水平较对照组更高，CD8⁺水平较对照组更低（P<0.05）；两组并发症发生率比较，差异无统计学意义（22.00%比16.67%，χ²=0.475，P=0.490）；研究组复发率较对照组更低（7.41%比24.00%，χ²=5.490，P=0.019）。

结论

相较于PTCS，复杂肝胆管结石患者应用超声引导下PTOBF取石术治疗可有效提高结石取净率、降低复发率，对免疫功能影响小，可改善肝功能，缩短患者术后恢复时间，不会增加并发症风险。

关键词: 肝胆管结石, 经皮经肝Ⅰ期胆道造瘘, 经皮经肝胆道镜, 超声引导

Objective

To compare the effects of ultrasound-guided percutaneous transhepatic one-stage biliary fistulization (PTOBF) and percutaneous transhepatic cholangioscopy (PTCS) on stone clearance and recurrence rate in patients with complex hepatobiliary duct stones.

Methods

A total of 104 patients with complex hepatobiliary duct stones admitted to Xinhua Hospital Affiliated to Anhui University of Science and Technology from January 2021 to January 2023 were selected. Clinical data were retrospectively analyzed and divided into different surgical groups. The control group received 50 cases of PTCS surgery, while the study group received 54 cases of ultrasound-guided PTOBF surgery. The perioperative indicators, stone clearance effect, immune function, stress response, liver function, complications, and recurrence rate were compared between the two groups.

Results

The study group had shorter postoperative exhaust time and defecation time compared to the control group (P<0.05); The study group had less intraoperative bleeding and stone removal frequency compared to the control group (P<0.05); The stone removal rate in the study group was higher than that in the control group (85.19% vs. 68.00%) (χ²=4.319, P=0.037). The levels of cortisol (Cor), adrenaline (E), and norepinephrine (NE) in both groups increased on postoperative day 1 and 3 compared to preoperative levels in the same group, and the levels of Cor, E, and NE were lower on postoperative day 3 compared to postoperative day 1 in the same group (P<0.05); One month after surgery, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in both groups decreased compared to preoperative levels in the same group, with the study group showing a more significant decrease (P<0.05); On the first day after surgery, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the study group were higher than those in the control group, while the level of CD8⁺ was lower (P<0.05); There was no statistically significant difference in the incidence of complications between the two groups (22.00% vs. 16.67%) (χ²=0.475, P=0.490); The recurrence rate in the study group was lower than that in the control group (7.41% vs. 24.00%) (χ²=5.490, P=0.019).

Conclusion

Compared with PTCS, ultrasound- guided PTOBF surgery can effectively improve the stone removal rate in patients with complex hepatobiliary duct stones, reduce the recurrence rate, have little impact on immune function, improve liver function, shorten the postoperative recovery time of patients, and will not increase the risk of complications.

Key words: Hepatobiliary stones, Percutaneous transhepatic one-stage biliary fistulization, Percutaneous transhepatic cholangioscopy, Ultrasound guidance

表1 两组复杂肝胆管结石患者围手术期指标比较（

±s）

组别	例数	取石时间(min)	术中出血量(mL)	术后排气时间(h)	术后排便时间(h)
对照组	50	67.77±11.69	30.36±4.87	7.29±1.63	8.52±2.65
研究组	54	64.94±12.41	26.97±5.22	3.87±1.89	4.17±2.72
t		1.194	3.417	9.845	8.249
P		0.235	0.007	0.002	0.004

表1 两组复杂肝胆管结石患者围手术期指标比较（

±s）

组别	例数	取石时间(min)	术中出血量(mL)	术后排气时间(h)	术后排便时间(h)
对照组	50	67.77±11.69	30.36±4.87	7.29±1.63	8.52±2.65
研究组	54	64.94±12.41	26.97±5.22	3.87±1.89	4.17±2.72
t		1.194	3.417	9.845	8.249
P		0.235	0.007	0.002	0.004

表2 两组复杂肝胆管结石患者手术应激状况比较（

±s）

组别	例数	时间	Cor(nmol/L)	E(ng/mL)	NE(ng/mL)
对照组	50	术前	143.54±12.96	135.47±13.21	102.96±10.15
		术后1天	169.98±13.28^a	177.65±12.48^a	128.96±9.47^a
		术后3天	156.36±10.44^ab	164.28±10.33^ab	116.87±10.22^ab
研究组	54	术前	144.12±12.29	134.98±13.85	103.12±10.22
		术后1天	173.24±10.18^a	181.71±13.12^a	130.12±9.58^a
		术后3天	161.66±10.37^ab	166.52±12.46^ab	120.21±8.93^ab
F_对照组/F_研究组			5.610/5.415	15.951/6.128	8.545/4.547
P_对照组/P_研究组			0.005/0.006	0.000/0.005	0.003/0.008

表2 两组复杂肝胆管结石患者手术应激状况比较（

±s）

组别	例数	时间	Cor(nmol/L)	E(ng/mL)	NE(ng/mL)
对照组	50	术前	143.54±12.96	135.47±13.21	102.96±10.15
		术后1天	169.98±13.28^a	177.65±12.48^a	128.96±9.47^a
		术后3天	156.36±10.44^ab	164.28±10.33^ab	116.87±10.22^ab
研究组	54	术前	144.12±12.29	134.98±13.85	103.12±10.22
		术后1天	173.24±10.18^a	181.71±13.12^a	130.12±9.58^a
		术后3天	161.66±10.37^ab	166.52±12.46^ab	120.21±8.93^ab
F_对照组/F_研究组			5.610/5.415	15.951/6.128	8.545/4.547
P_对照组/P_研究组			0.005/0.006	0.000/0.005	0.003/0.008

表3 两组复杂肝胆管结石患者肝功能比较（

±s）

组别	例数	时间	AST(U/L)	ALT(U/L)
对照组	50	术前	63.55±8.69	76.29±10.28
对照组	50	术后1个月	41.63±5.46^a	44.23±6.59^a
研究组	54	术前	64.12±8.27	75.99±10.37
研究组	54	术后1个月	40.89±5.32^ac	40.98±7.82^ac
t_对照组/t_研究组			5.102/7.359	8.565/9.808
P_对照组/P_研究组			0.006/0.003	0.002/0.001

表3 两组复杂肝胆管结石患者肝功能比较（

±s）

组别	例数	时间	AST(U/L)	ALT(U/L)
对照组	50	术前	63.55±8.69	76.29±10.28
对照组	50	术后1个月	41.63±5.46^a	44.23±6.59^a
研究组	54	术前	64.12±8.27	75.99±10.37
研究组	54	术后1个月	40.89±5.32^ac	40.98±7.82^ac
t_对照组/t_研究组			5.102/7.359	8.565/9.808
P_对照组/P_研究组			0.006/0.003	0.002/0.001

表4 两组复杂肝胆管结石患者免疫功能比较（

±s）

组别	例数	时间	CD3⁺(%)	CD4⁺(%)	CD8⁺(%)	CD4⁺/CD8⁺
对照组	50	术前	64.88±7.39	42.18±3.45	28.15±2.25	1.33±0.39
对照组	50	术后1天	51.98±6.87^a	37.15±2.33^a	33.99±2.25^a	1.18±0.12^a
研究组	54	术前	65.12±7.52	42.39±3.54	28.33±2.16	1.31±0.41
研究组	54	术后1天	57.63±6.15^ac	39.12±2.22^ac	30.45±2.07^ac	1.25±0.18^c
t_对照组/t_研究组			9.040/5.665	8.543/5.750	12.977/5.207	2.599/0.984
P_对照组/P_研究组			0.001/0.007	0.002/0.007	0.000/0.006	0.010/0.327

表4 两组复杂肝胆管结石患者免疫功能比较（

±s）

组别	例数	时间	CD3⁺(%)	CD4⁺(%)	CD8⁺(%)	CD4⁺/CD8⁺
对照组	50	术前	64.88±7.39	42.18±3.45	28.15±2.25	1.33±0.39
对照组	50	术后1天	51.98±6.87^a	37.15±2.33^a	33.99±2.25^a	1.18±0.12^a
研究组	54	术前	65.12±7.52	42.39±3.54	28.33±2.16	1.31±0.41
研究组	54	术后1天	57.63±6.15^ac	39.12±2.22^ac	30.45±2.07^ac	1.25±0.18^c
t_对照组/t_研究组			9.040/5.665	8.543/5.750	12.977/5.207	2.599/0.984
P_对照组/P_研究组			0.001/0.007	0.002/0.007	0.000/0.006	0.010/0.327

表5 两组复杂肝胆管结石患者术后并发症及复发率比较[例（%）]

组别	例数	胆道感染	瘘道穿孔	出血	脱管	不良反应发生率	复发率
对照组	50	5(10.00)	3(6.00)	1(2.00)	2(4.00)	11(22.00)	12(24.00)
研究组	54	4(7.41)	0(0.00)	5(9.26)	0(0.00)	9(16.67)	4(7.41)
χ²						0.475	5.490
P						0.490	0.019

表5 两组复杂肝胆管结石患者术后并发症及复发率比较[例（%）]

组别	例数	胆道感染	瘘道穿孔	出血	脱管	不良反应发生率	复发率
对照组	50	5(10.00)	3(6.00)	1(2.00)	2(4.00)	11(22.00)	12(24.00)
研究组	54	4(7.41)	0(0.00)	5(9.26)	0(0.00)	9(16.67)	4(7.41)
χ²						0.475	5.490
P						0.490	0.019

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Comparative analysis of stone clearance effect and recurrence rate between ultrasound-guided percutaneous transhepatic one-stage biliary fistulization and percutaneous transhepatic cholangioscopy in patients with complex hepatobiliary stones

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Comparative analysis of stone clearance effect and recurrence rate between ultrasound-guided percutaneous transhepatic one-stage biliary fistulization and percutaneous transhepatic cholangioscopy in patients with complex hepatobiliary stones