Department of Ultrasound, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China.
Department of Hepatobiliary Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Meihua Dong Road, No. 52, Zhuhai, 519000, Guangdong, China.
World J Surg. 2023 Dec;47(12):3338-3347. doi: 10.1007/s00268-023-07217-9. Epub 2023 Oct 11.
As a minimally invasive treatment for common bile duct (CBD) stones, ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) is gaining attention and recognition from the medical community.
A retrospective analysis was conducted on patients with CBD stones treated in our hospital from January 2016 to April 2022. Patients were divided into three groups: 77 treated with PTCSL, 93 with endoscopic retrograde cholangiopancreatography (ERCP), and 103 with laparoscopic common bile duct exploration (LCBDE). Their clinical data, perioperative indicators, and complications were analyzed comparatively. Then, risk factors for the post-PTCSL recurrence of CBD stones were analyzed by logistic regressions. Finally, the receiver operating characteristic curve was drawn.
All perioperative indicators of the PTCSL group were better than the LCBDE group (P < 0.001). The incidences of cholangitis, hemobilia, and incisional infection after surgery were lower in the PTCSL group than in the LCBDE group (P < 0.05). Pancreatitis, reflux esophagitis, and papillary stenosis occurred less frequently in the PTCSL group than in the ERCP group (P < 0.05). Logistic regression analysis indicated that gallstones and family history were independent risk factors. The AUC for recurrent CBD stones predicted by multi-indicators was 0.895 (95% CI 0.792-0.999, P < 0.001) with a sensitivity of 96.7% and specificity of 68.8%.
Ultrasound-guided PTCSL is a safe and effective treatment for CBD stones. Patients recovered quickly with fewer postoperative complications. It can be a first-line treatment for CBD stones. Gallstones and family history are independent risk factors for recurrent CBD stones, which provide a reference for clinicians in identifying the high-risk population needing close follow-up.
超声引导经皮经肝胆道镜碎石术（PTCSL）作为一种微创治疗方法，正在获得医学界的关注和认可。
回顾性分析了 2016 年 1 月至 2022 年 4 月我院收治的胆总管结石患者。将患者分为三组：77 例接受 PTCSL 治疗，93 例接受内镜逆行胰胆管造影术（ERCP）治疗，103 例接受腹腔镜胆总管探查术（LCBDE）治疗。比较分析了三组患者的临床资料、围手术期指标及并发症，并采用 logistic 回归分析 PTCSL 后胆总管结石复发的危险因素，最后绘制受试者工作特征曲线。
PTCSL 组的所有围手术期指标均优于 LCBDE 组（P < 0.001）。PTCSL 组术后胆管炎、出血、切口感染的发生率低于 LCBDE 组（P < 0.05）。PTCSL 组胰腺炎、反流性食管炎、乳头狭窄的发生率低于 ERCP 组（P < 0.05）。多因素 logistic 回归分析表明，胆囊结石和家族史是独立的危险因素。多指标预测胆总管结石复发的 AUC 为 0.895（95%CI 0.792-0.999，P < 0.001），灵敏度为 96.7%，特异度为 68.8%。
超声引导下 PTCSL 是一种安全有效的治疗胆总管结石的方法。患者术后恢复快，并发症少。它可以作为胆总管结石的一线治疗方法。胆囊结石和家族史是胆总管结石复发的独立危险因素，为临床医生识别需要密切随访的高危人群提供了参考。
