目的：探讨B超定位联合X线引导经皮经肝穿刺碎石取石术对肝内胆管结石的临床效果。方法：选取2015年6月—2016年2月在收治的肝内胆管结石患者，并随机分为对照组和观察组，每组30例，观察组行B超定位联合X线引导经皮经肝穿刺碎石取石术，对照组行单纯X线引导经皮经肝穿刺碎石取石术，比较两组患者相关临床指标以及术后6个月生活质量情况。结果：与对照组比较，观察组住院时间和胃肠道蠕动恢复时间均无统计学差异（均P>0.05），但手术时间明显缩短（69.46 min vs. 158.67 min），出血量明显减少（35.15 mL vs. 102.76 mL），手术成功例数增多（30例vs. 25例），结石残留和近期复发例数明显减少（0例vs. 6例；0例vs. 4例），术后急性胰腺炎、急性胆管炎、胆汁漏和出血发生率明显降低，术后6个月SF-36量表各项指标评分均明显增高（均P<0.05）。结论：B超定位联合X线引导经皮经肝穿刺碎石取石术治疗肝内胆管结石是一种安全、有效、简便的方法，具有定位准确、结石残留率低、手术时间短、术后并发症少等优点。
Percutaneous transhepatic stone disintegration and extraction under B ultrasound positioning and X-ray guidance for intrahepatic stones
Objective: To evaluate the clinical efficacy of percutaneous transhepatic stone disintegration and extraction in treatment of hepatolithiasis under B ultrasound positioning and X-ray guidance. Methods: Patients with intrahepatic stones admitted from June 2015 to February 2016 were selected, and then were randomly designated to observational group and control group, with 30 cases in each group. Patients in observational group underwent percutaneous transhepatic stone disintegration and extraction under B ultrasound positioning and X-ray guidance, and those in control group underwent percutaneous transhepatic stone disintegration and extraction under X-ray guidance alone. The relevant clinical variables and the quality of life between the two groups at 6 months after operation were compared. Results: In observational group compared with control group, the length of hospital stay and time to bowel function recovery showed no significant difference (both P>0.05), but operative time (69.46 min vs. 158.67 min), intraoperative blood loss (35.15 mL vs. 102.76 mL) were significantly reduced, the number of cases with surgical success (30 vs. 25) was significantly increased, the number of cases with residual stones (0 vs. 6) and early recurrence (0 vs. 4) were significantly decreased, the incidence of postoperative acute pancreatitis, acute cholangitis, bile leakage and hemorrhage were all significantly decreased, and the scores for all parameters of the SF-36 at 6 months after operation were all significantly elevated (all P<0.05). Conclusion: Percutaneous transhepatic stone disintegration and extraction under B ultrasound positioning and X-ray guidance is a safe, effective and convenient method of treatment for hepatolithiasis. It also has advantages of accurate location, high stone clearance rate, short operative time and fewer complications.