Department of Interventional Medicine, The Second Hospital of Shandong University, Jinan 250033, Shandong Province, China.
Department of General Surgery, Jiyang County People's Hospital, Jinan 251400, Shandong Province, China.
World J Gastroenterol. 2018 Sep 7;24(33):3799-3805. doi: 10.3748/wjg.v24.i33.3799.
To evaluate the clinical efficacy and safety of an innovative percutaneous transhepatic extraction and balloon dilation (PTEBD) technique for clearance of gallbladder stones in patients with concomitant stones in the common bile duct (CBD).
The data from 17 consecutive patients who underwent PTEBD for clearance of gallbladder stones were retrospectively analyzed. After removal of the CBD stones by percutaneous transhepatic balloon dilation (PTBD), the gallbladder stones were extracted to the CBD and pushed into the duodenum with a balloon after dilation of the sphincter of Oddi. Large stones were fragmented using a metallic basket. The patients were monitored for immediate adverse events including hemorrhage, perforation, pancreatitis, and cholangitis. During the two-year follow-up, they were monitored for stone recurrence, reflux cholangitis, and other long-term adverse events.
Gallbladder stones were successfully removed in 16 (94.1%) patients. PTEBD was repeated in one patient. The mean hospitalization duration was 15.9 ± 2.2 d. Biliary duct infection and hemorrhage occurred in one (5.9%) patient. No severe adverse events, including pancreatitis or perforation of the gastrointestinal or biliary tract occurred. Neither gallbladder stone recurrence nor refluxing cholangitis had occurred two years after the procedure.
Sequential PTBD and PTEBD are safe and effective for patients with simultaneous gallbladder and CBD stones. These techniques provide a new therapeutic approach for certain subgroups of patients in whom endoscopic retrograde cholangiopancreatography/endoscopic sphincterotomy or surgery is not appropriate.
评估经皮经肝胆囊结石取石术联合球囊扩张术（PTEBD）治疗胆总管结石合并胆囊结石的临床疗效和安全性。
回顾性分析 17 例连续接受 PTEBD 治疗的患者资料。经皮经肝球囊扩张术（PTBD）取出胆总管结石后，扩张Oddi 括约肌，将胆囊结石推至胆总管并推入十二指肠，用球囊将其粉碎。较大的结石用金属篮取出。监测患者有无立即出现的出血、穿孔、胰腺炎和胆管炎等不良事件。在 2 年的随访期间，监测患者有无结石复发、反流性胆管炎和其他长期不良事件。
16 例（94.1%）患者成功取出胆囊结石，1 例患者重复进行了 PTEBD。平均住院时间为 15.9±2.2d。1 例（5.9%）患者发生胆道感染和出血。无胰腺炎或胃肠道或胆道穿孔等严重不良事件。术后 2 年，均未出现胆囊结石复发或反流性胆管炎。
序贯 PTBD 和 PTEBD 治疗胆囊结石合并胆总管结石是安全有效的。对于内镜逆行胰胆管造影/内镜括约肌切开术或手术不适合的某些特定亚组患者，这些技术为其提供了一种新的治疗方法。
