General Surgery Center, Chengdu Military General Hospital, Chengdu, China.
Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Dig Endosc. 2018 May;30(3):372-379. doi: 10.1111/den.12987. Epub 2017 Dec 12.
Although postoperative cholangioscopy (POC) is considered to be an effective treatment for residual hepatolithiasis after surgery, its security and validity still need to be improved. This study compared wire-guided POC (WG-POC) versus traditional POC (T-POC) in the management of patients with residual hepatolithiasis.
This retrospective study included a total of 203 patients who suffered from hepatolithiasis and underwent hepatectomy as initial intervention from 1 January 2016 to 1 January 2017. After surgery, 110 patients were subjected to T-POC and 93 to WG-POC for eliminating residual hepatolithiasis. Perioperative course and follow-up outcomes were retrospectively analyzed.
No significant differences in clinical characteristics or distribution of residual hepatolithiasis between the WG-POC and T-POC groups were observed (P > 0.05). However, overall POC interventional sessions (2.9 ± 0.85 vs 4.0 ± 1.21 times), average operating time (264.8 ± 103.61 vs 389.4 ± 136.26 min), overall complications rate (18.28% vs 32.73%), and overall T-tube retaining time (21.8 ± 6.20 vs 28.8 ± 8.09 days) were lower in the WG-POC group than in the T-POC group (P < 0.05). In addition, there were no significant differences between the two groups (WG-POC vs T-POC) in recurrence (4.30% vs 4.55%) and residual calculi (8.60% vs 6.36%) at half-a-year follow up (P > 0.05).
Routine wire guidance may improve the outcome of cholangioscopy in managing complicated residual hepatolithiasis, being associated with clear advantages such as shorter operating time and number of POC interventions, reduced T-tube retaining time, and fewer postoperative complications.
尽管术后胆管镜检查（POC）被认为是治疗手术后残余肝胆管结石的有效方法，但仍需要提高其安全性和有效性。本研究比较了导丝引导下 POC（WG-POC）与传统 POC（T-POC）在处理残余肝胆管结石患者中的效果。
本回顾性研究纳入了 203 例因肝胆管结石接受肝切除术作为初始干预的患者，这些患者的手术时间均为 2016 年 1 月 1 日至 2017 年 1 月 1 日。术后，110 例患者接受 T-POC，93 例患者接受 WG-POC 以清除残余肝胆管结石。回顾性分析围手术期过程和随访结果。
WG-POC 组与 T-POC 组患者的临床特征或残余肝胆管结石分布无显著差异（P > 0.05）。然而，WG-POC 组的总 POC 介入次数（2.9 ± 0.85 次比 4.0 ± 1.21 次）、平均手术时间（264.8 ± 103.61 分钟比 389.4 ± 136.26 分钟）、总并发症发生率（18.28%比 32.73%）和总 T 管留置时间（21.8 ± 6.20 天比 28.8 ± 8.09 天）均低于 T-POC 组（P < 0.05）。此外，两组在半年随访时的复发率（4.30%比 4.55%）和残余结石率（8.60%比 6.36%）无显著差异（P > 0.05）。
常规导丝引导可能改善复杂残余肝胆管结石患者行胆管镜检查的效果，具有手术时间和 POC 介入次数更少、T 管留置时间更短、术后并发症更少等明显优势。
