背景:胆结石是一种非常普遍的疾病,也是全球住院的主要原因。传统的多次经皮肝穿刺胆道镜碎石术(PTCSL)后,肝胆管结石伴相关狭窄的残留和复发率很高。
目的:在三维(3D)可视化的指导下,使用经皮经肝穿刺一步胆道瘘(PTOBF)技术研究一步PTCSL。
方法:这是一个回顾性研究,单中心研究分析,140名患者,在2016年10月至2023年10月期间,针对肝胆管结石进行了一步法PTCSL.将患者分为两组:3D-PTOBF组和PTOBF组。胆道镜检查结石清除,并发症,并评估长期清除率和复发率.
结果:年龄,总胆红素,直接胆红素,Child-Pugh班,两组之间的石头位置相似,但是胆管狭窄有显著差异,胆道狭窄在3D-PTOBF组更为常见(P=0.001)。中位随访时间为55.0(55.0,512.0)天。即时结石清除率(88.6%vs27.1%,P=0.000)和狭窄分辨率(97.1%vs78.6%,3D-PTOBF组P=0.001)显著年夜于PTOBF组。术后并发症(8.6%vs41.4%,P=0.000)和结石复发率(7.1%vs38.6%,P=0.000)在3D-PTOBF组中明显降低。
结论:三维可视化有助于使一步法PTCSL成为安全的,有效,并有望治疗复杂的原发性肝胆管结石患者。复杂的原发性肝胆管结石患者的围手术期和长期预后令人满意。这种微创方法有可能替代肝胆手术。
BACKGROUND: Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL).
OBJECTIVE: To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization.
METHODS: This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed.
RESULTS: Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group (P = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% vs 27.1%, P = 0.000) and stricture resolution ratio (97.1% vs 78.6%, P = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% vs 41.4%, P = 0.000) and stone recurrence rates (7.1% vs 38.6%, P = 0.000) were significantly lower in the 3D-PTOBF group.
CONCLUSIONS: Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.