Training School in Radiology, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.
Department of Diagnostic and Interventional Radiology, Humanitas Clinical and Research Center - IRCCS, Via A. Manzoni 56, 20089, Rozzano, Milan, Italy.
Abdom Radiol (NY). 2020 Aug;45(8):2561-2568. doi: 10.1007/s00261-020-02554-y.
To evaluate the efficacy and safety of percutaneous transhepatic endoscopic holmium laser biliary lithotripsy (PTBL) to treat recurrent cholangitis due to intra/extrahepatic stones, in patients not candidate for traditional endoscopic treatment.
We retrospectively evaluated 28 patients (M:F = 19:9, mean age = 65 years, SD = 14) undergoing 43 PTBL for stone-related recurrent cholangitis from January 1, 2012 to January 31, 2019 in a single academic center. Data collected included demographics, location and number of stones, clinical success after one (primary) or more than one (secondary) PTBL, procedure time, duration of hospital stay, number of retreatments and post-procedural complications. Clinical success was defined as the resolution of cholangitis at 30-day follow-up.
PTBL were successful for 23/28 (82%) patients, 16 (57%) with one and 7 (88%) with repeat procedures. The remaining 5 (18%) patients were finally treated with surgery (3, 11%) or further antibiotics (2, 7%). PTBL were performed to treat intrahepatic stones (22 treatments, 51%), extrahepatic (14, 33%), and both intra/extrahepatic (7, 16%). One to three stones were found in 12/43 (28%) PTBL, more than three in 31/43 (72%). Single PTBL was performed in 20/28 (71%) patients, two in 3/28 (11%), three in 3/28 (11%), and four in 2/28 (7%). Median procedure duration was 115 (29-210, 95% CI 101-129) minutes; median hospital stay was 5.5 (2-42) days. The only major complication was the breakage of a guidewire tip, surgically retrieved; minor complications included one aspiration pneumonia and three instances of intrahepatic hemorrhage, treated conservatively.
PTBL was clinically successful in the 82% of patients not candidate for endoscopic treatment, with a low complication rate.
评估经皮经肝内镜钬激光胆道碎石术（PTBL）治疗因肝内外结石引起的复发性胆管炎的疗效和安全性，这些患者不适宜进行传统的内镜治疗。
我们回顾性评估了 2012 年 1 月 1 日至 2019 年 1 月 31 日期间，在一家学术中心接受 43 次 PTBL 治疗因结石相关复发性胆管炎的 28 例患者（男 19 例，女 9 例，平均年龄 65 岁，标准差 14 岁）。收集的数据包括人口统计学、结石位置和数量、一次（初次）或多次（二次）PTBL 后的临床成功率、手术时间、住院时间、再治疗次数和术后并发症。临床成功定义为 30 天随访时胆管炎得到缓解。
28 例患者中，23 例（82%）PTBL 成功，16 例（57%）患者接受一次治疗，7 例（88%）患者接受重复治疗。其余 5 例（18%）患者最终接受了手术（3 例，11%）或进一步的抗生素治疗（2 例，7%）。PTBL 用于治疗肝内结石（22 次治疗，51%）、肝外结石（14 次，33%）和肝内外结石（7 次，16%）。43 次 PTBL 中，12 次（28%）发现 1-3 颗结石，31 次（72%）发现 3 颗以上结石。20 例（71%）患者单次行 PTBL，3 例（11%）患者行 2 次，3 例（11%）患者行 3 次，2 例（7%）患者行 4 次。中位手术时间为 115（29-210，95%CI 101-129）分钟；中位住院时间为 5.5（2-42）天。唯一的主要并发症是导丝尖端断裂，通过手术取出；轻微并发症包括 1 例吸入性肺炎和 3 例肝内出血，均经保守治疗。
对于不适合内镜治疗的患者，PTBL 的临床成功率为 82%，并发症发生率低。
