关键词: Hepatolithiasis Percutaneous transhepatic choledochoscopy Reoperation

Mesh : Humans Liver Diseases / surgery Lithiasis / surgery Retrospective Studies Reproducibility of Results Calculi Ultrasonography, Interventional Treatment Outcome

来  源:   DOI:10.1186/s12893-024-02370-x   PDF(Pubmed)

Abstract:
OBJECTIVE: Percutaneous transhepatic one-step biliary fistulation (PTOBF) is used to treat choledocholithiasis and biliary stricture. This study aimed to evaluate the safety and efficacy of ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of recurrent hepatolithiasis.
METHODS: The clinical data of 37 consecutive patients who underwent PTOBF combined with rigid choledochoscopy for RHL from March 2020 to March 2022 at our hospital were retrospectively analyzed.
RESULTS: A total of 68 percutaneous transhepatic punctures were performed in 37 patients, with a puncture success rate of 85.29% (58/68) and a dilatation success rate of 100.00% (58/58). The mean blood loss of operation was 9.84 ± 18.10 mL, the mean operation time was 82.05 ± 31.92 min, and the mean length of postoperative hospital stay was 5.59 ± 3.26 days. The initial stone clearance rate was 40.54% (15/37) and the final stone clearance rate was 100% (37/37). The incidence of postoperative complications was 10.81% (4/37), including 2 cases of pleural effusion, 1 case of hemorrhage, and 1 case of cholangitis, which recovered after treatment. During a mean follow-up period of 23 months (range 12 to 36 months), only 1 patient experienced stone recurrence.
CONCLUSIONS: Ultrasound-guided PTOBF combined with rigid choledochoscopy in the treatment of RHL based on skilful manipulation seems to be a safe, effective and minimally invasive method with clinical application value. Further comparative studies with large sample sizes are needed in the future to confirm the reliability of its therapeutic results.
摘要:
目的:经皮肝穿刺一步法胆道瘘(PTOBF)用于治疗胆总管结石和胆道狭窄。本研究旨在评估超声引导下PTOBF联合硬性胆道镜治疗复发性肝胆管结石的安全性和有效性。
方法:回顾性分析2020年3月至2022年3月在我院行PTOBF联合硬性胆道镜行RHL的37例患者的临床资料。
结果:37例患者共进行了68例经皮经肝穿刺,穿刺成功率85.29%(58/68),扩张成功率100.00%(58/58)。手术平均失血9.84±18.10mL,平均手术时间82.05±31.92min,术后平均住院时间为5.59±3.26天。初始结石清除率为40.54%(15/37),最终结石清除率为100%(37/37)。术后并发症发生率为10.81%(4/37),其中胸腔积液2例,1例出血,1例胆管炎,治疗后恢复。在平均23个月的随访期间(范围12至36个月),只有1例患者出现结石复发。
结论:超声引导下PTOBF联合刚性胆道镜治疗基于熟练操作的RHL似乎是安全的,有效的微创方法,具有临床应用价值。将来需要进行大样本量的进一步比较研究,以确认其治疗结果的可靠性。
公众号