Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei Province, China.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510282, Guangdong Province, China.
World J Surg. 2020 May;44(5):1586-1594. doi: 10.1007/s00268-020-05368-7.
The aim of this study was to compare the outcomes of one-step multichannel percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) with traditional PTCSL in the treatment of bilateral hepatolithiasis.
From February 2011 to June 2015, 156 patients with bilateral hepatolithiasis received surgical treatment in our department. Among these patients, 81 received one-step multichannel PTCSL (group A), and the remaining 75 received traditional PTCSL (group B).
Compared with group B, group A was characterized by a significantly shorter operation time (83.7 ± 28.5 min vs 118.1 ± 41.5 min; P = 0.000), hospital stay (11.1 ± 3.4 d vs 17.8 ± 5.6 d; P = 0.034), and postoperative hospital stay (6.9 ± 3.1 d vs 9.6 ± 4.5 d; P = 0.026). In addition, the immediate clearance (62.9% vs 45.3%, P = 0.027) and final clearance (90.1% vs 78.7%, P = 0.048) rates were higher in group A than in group B. During the follow-up period, stone recurrence was significantly less common in group A than in group B (13.6% vs 26.7%, P = 0.041). Multivariate Cox analysis showed that the PTCSL method (HR = 2.32, 95% confidence interval [CI] = 1.09-4.90, P = 0.028), bilateral biliary stricture (HR = 4.17, 95% CI = 1.73-10.03, P = 0.001), and stones located in segments I (HR = 7.75, 95% CI = 3.67-16.38, P = 0.000) were independent predictors of recurrence.
Compared with traditional PTCSL, one-step multichannel PTCSL was more efficient and effective in the treatment of bilateral hepatolithiasis.
本研究旨在比较一步法多通道经皮经肝胆道镜碎石术（PTCSL）与传统 PTCSL 治疗双侧肝胆管结石的效果。
2011 年 2 月至 2015 年 6 月，我科共收治 156 例双侧肝胆管结石患者，其中 81 例行一步法多通道 PTCSL（A 组），75 例行传统 PTCSL（B 组）。
与 B 组相比，A 组手术时间（83.7±28.5min 比 118.1±41.5min；P=0.000）、住院时间（11.1±3.4d 比 17.8±5.6d；P=0.034）和术后住院时间（6.9±3.1d 比 9.6±4.5d；P=0.026）更短，即刻清石率（62.9%比 45.3%；P=0.027）和最终清石率（90.1%比 78.7%；P=0.048）更高。随访期间，A 组结石复发率明显低于 B 组（13.6%比 26.7%；P=0.041）。多因素 Cox 分析显示，PTCSL 方法（HR=2.32，95%置信区间[CI]：1.09-4.90，P=0.028）、双侧胆管狭窄（HR=4.17，95%CI：1.73-10.03，P=0.001）和结石位于 I 段（HR=7.75，95%CI：3.67-16.38，P=0.000）是结石复发的独立预测因素。
与传统 PTCSL 相比，一步法多通道 PTCSL 治疗双侧肝胆管结石更有效。
