Digestion. 2018;97(3):267-274. doi: 10.1159/000485179. Epub 2018 Feb 9.
Bile duct stones (BDS) are usually removed via endoscopic retrograde cholangiopancreatography (ERCP) or, if ERCP remains unsuccessful, percutaneous transhepatic cholangiodrainage (PTCD). However, PTCD provides limited access to large BDSs. We analyzed a modified approach of PTCD for percutaneous therapy of BDS.
We used a modified approach of PTCD with a 13-french (Fr) hemostasis introducer for transhepatic access to BDS. Short-wired balloon or basket catheter were applied for safe removal of BDS. Patient characteristics, effectiveness, and complications were analyzed.
We identified 11 patients who underwent PTCD with hemostasis introducer. BDSs were either pushed forward to the duodenum (36%) or both partly pushed and extracted via hemostasis introducer (64%). In some cases, mechanical lithotripsy was necessary (45%). Complete removal of BDS was initially achieved in 36% of patients, 45% received additional PTCD, and in 19% stent implantation was performed. Finally, all BDSs could be removed. Laboratory analysis revealed significant reduction of alkaline phosphatase (p = 0.03) and C reactive protein (p = 0.03). Complications occurred only in 1 patient with post-interventional cholangitis.
Our study showed feasibility and safety of a modified PTCD with hemostasis introducer. In addition, protection of liver tissue from sharp-edged catheters and stones was achieved. Therefore, our modification revealed an innovational approach for transhepatic removal of BDS.
胆管结石（BDS）通常通过内镜逆行胰胆管造影术（ERCP）取出，如果 ERCP 仍然不成功，则通过经皮经肝胆管引流术（PTCD）取出。然而，PTCD 对大 BDS 的进入有限。我们分析了一种改良的 PTCD 方法，用于经皮治疗 BDS。
我们使用改良的 PTCD 方法，使用 13 号（Fr）止血引导器进行经肝入路治疗 BDS。短丝球囊或篮状导管用于安全取出 BDS。分析患者特征、疗效和并发症。
我们确定了 11 例接受 PTCD 加止血引导器治疗的患者。BDS 要么被推到十二指肠（36%），要么部分被推并通过止血引导器取出（64%）。在某些情况下，需要进行机械碎石术（45%）。最初，36%的患者成功取出了所有的 BDS，45%的患者接受了额外的 PTCD，19%的患者接受了支架植入。最终，所有的 BDS 都被取出。实验室分析显示碱性磷酸酶（p=0.03）和 C 反应蛋白（p=0.03）显著降低。仅 1 例患者发生介入后胆管炎并发症。
我们的研究表明，改良的带止血引导器的 PTCD 具有可行性和安全性。此外，还实现了对肝脏组织免受尖锐导管和结石的损伤。因此，我们的改良方法为经皮肝内去除 BDS 提供了一种创新方法。
