Division of Hepatopancreatobiliary Surgery, Digestive Disease Center, Department of Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 304833, Singapore.
Surgeon. 2011 Apr;9(2):88-94. doi: 10.1016/j.surge.2010.08.002.
Hepatolithiasis is a challenging condition to treat especially in patients with previous hepatobiliary surgery. Percutaneous Transhepatic Cholangioscopic Lithotripsy (PTCSL) is an attractive salvage option for the treatment of recurrent hepatolithiasis. We reviewed our experience using PTCSL in treating 4 patients with previous complex abdominal surgery.
We studied the 4 patients who underwent PTCSL from October 2007 to July 2009. We reviewed the operative procedures, workflow of performing PTCSL in our institution and the outcome of the procedure. PTCSL was performed in our institution using 3 mm cholangioscope (Dornier MedTech(®)) and Holmium laser with setting at 0.8 J, 20 Hz and 16 W. This was performed through a Percutaneous Transhepatic Cholangio-catheter inserted by interventional radiologists.
There were 4 patients with a median age of 50 (43-69) years. The median duration of the condition prior to PTCSL was 102 (60-156) months. Three patients had recurrent pyogenic cholangitis (RPC) with recurrent intrahepatic stone. They all had prior complex hepatobiliary operations. The median duration of surgery was 130 (125-180) min. There was minimal intra-operative blood loss. The first procedure was performed under local anaesthesia and sedation, however, with experience the subsequent 3 patients had the procedure performed under general anaesthesia. The median size of bile duct was 18 (15-20) mm prior to the procedure. The number of stones ranged from one to three with the largest size of stone comparable to the size of bile duct. The median follow up was 18 (10-24) months. All patients were symptom free with neither stone recurrence or cholangitis at the last follow up.
PTCSL is a feasible and an effective treatment method for patients with recurrent biliary stone following complex abdominal surgery as the success rates from open surgery and endoscopic procedures are limited. Excellent results can be expected with this minimally invasive technique.
肝内胆管结石的治疗极具挑战性，尤其是对于既往有肝胆外科手术史的患者。经皮经肝胆道镜碎石术（PTCSL）是治疗复发性肝内胆管结石的一种有吸引力的挽救性选择。我们回顾了我们使用 PTCSL 治疗 4 例既往复杂腹部手术患者的经验。
我们研究了 2007 年 10 月至 2009 年 7 月期间接受 PTCSL 的 4 例患者。我们回顾了手术过程、我院行 PTCSL 的工作流程以及手术结果。我院采用 3mm 胆道镜（多尼尔医疗技术公司）和钬激光进行 PTCSL，设置为 0.8J、20Hz 和 16W。这是通过介入放射科医生插入的经皮经肝胆管导管进行的。
患者的中位年龄为 50 岁（43-69 岁）。PTCSL 前的中位病程为 102 个月（60-156 个月）。3 例患者均有复发性化脓性胆管炎（RPC）伴肝内复发性结石。他们均有既往复杂的肝胆手术史。手术的中位时间为 130 分钟（125-180 分钟）。术中出血量少。首次手术在局部麻醉和镇静下进行，但随着经验的积累，随后的 3 例患者在全身麻醉下进行了手术。术前胆管中位直径为 18mm（15-20mm）。结石数量从 1 个到 3 个不等，最大结石与胆管直径相当。中位随访时间为 18 个月（10-24 个月）。末次随访时，所有患者均无症状，无结石复发或胆管炎。
PTCSL 是一种可行且有效的治疗方法，适用于既往复杂腹部手术后复发性胆道结石患者，因为开放手术和内镜治疗的成功率有限。这种微创技术可以取得优异的效果。
