Zhang Peng, Dang Xi, Li Xiaojie, Liu Bo, Wang Qingliang
Department of General Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Department of Laboratory Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Surg Open Sci. 2024 May 31;20:38-44. doi: 10.1016/j.sopen.2024.05.015. eCollection 2024 Aug.
Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) provides an effective alternative procedure for the management of complex hepatolithiasis and choledocholithiasis. Enhanced recovery after surgery (ERAS) program is an evidence-based approach that was developed to reduce surgical stress and accelerate postoperative recovery. However, little is known regarding PTCSL in the context of ERAS. The aim of this study was to evaluate the efficacy and safety of PTCSL within ERAS programs.
The clinical data of patients who underwent PTCSL within ERAS programs consulted at our hospital between November 2017 and November 2022 was retrospectively reviewed. Individualized perioperative ERAS items were evaluated for all patients. The demographics, intraoperative variables, and postoperative outcomes were analyzed.
A total of 43 patients who underwent PTCSL were included in the study. There were 13 men and 30 women aged between 39 and 89 years with an average age of 60 years (60.49 ± 12.37). The stone clearance rate was 77 % after the first operation, and the final clearance rate was 95 %. The incidence of complications in this study is 18.6 % (8/43), including 6 patients with Clavien-Dindo I-II, and 2 patients with Clavien-Dindo III. Pleural effusion, abdominal effusion, infection, bile leakage, and biliary bleeding are the most common complications, however, all patients recovered after aggressive treatment.
PTCSL is a relatively safe, feasible, and efficient method for treating complex hepatolithiasis and choledocholithiasis within ERAS programs. Individualized ERAS entries and precise disease management are required to minimize the occurrence of complications and to provide effective treatment.
经皮经肝胆道镜碎石术（PTCSL）为复杂肝内胆管结石和胆总管结石的治疗提供了一种有效的替代方法。加速康复外科（ERAS）计划是一种基于证据的方法，旨在减轻手术应激并加速术后康复。然而，关于ERAS背景下的PTCSL知之甚少。本研究的目的是评估ERAS计划中PTCSL的有效性和安全性。
回顾性分析2017年11月至2022年11月在我院接受ERAS计划下PTCSL治疗的患者的临床资料。对所有患者的个体化围手术期ERAS项目进行评估。分析患者的人口统计学特征、术中变量和术后结果。
本研究共纳入43例行PTCSL的患者。其中男性13例，女性30例，年龄39至89岁，平均年龄60岁（60.49±12.37）。首次手术后结石清除率为77%，最终清除率为95%。本研究中并发症发生率为18.6%（8/43），其中Clavien-Dindo I-II级6例，Clavien-Dindo III级2例。胸腔积液、腹腔积液、感染、胆漏和胆道出血是最常见的并发症，不过，所有患者经积极治疗后均康复。
PTCSL是在ERAS计划中治疗复杂肝内胆管结石和胆总管结石的一种相对安全、可行且有效的方法。需要个体化的ERAS项目和精确的疾病管理，以尽量减少并发症的发生并提供有效的治疗。
