Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China.
Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China.
World J Gastroenterol. 2024 Jul 28;30(28):3393-3402. doi: 10.3748/wjg.v30.i28.3393.
Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL).
To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization.
This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed.
Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group ( = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% 27.1%, = 0.000) and stricture resolution ratio (97.1% 78.6%, = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% 41.4%, = 0.000) and stone recurrence rates (7.1% 38.6%, = 0.000) were significantly lower in the 3D-PTOBF group.
Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
胆石病是一种高发疾病，也是全球范围内导致住院的主要原因。肝内胆管结石伴狭窄患者行传统多次经皮经肝胆道镜碎石取石术（PTCSL）后，残余结石和复发率较高。
研究三维（3D）可视化引导下经皮经肝胆道一次性造瘘术（PTOBF）在一次性 PTCSL 中的应用。
这是一项回顾性、单中心研究，分析了 2016 年 10 月至 2023 年 10 月期间 140 例因肝内胆管结石而行一次性 PTCSL 的患者。患者分为两组：3D-PTOBF 组和 PTOBF 组。评估胆总管镜下结石清除率、并发症及长期清除率和复发率。
两组患者的年龄、总胆红素、直接胆红素、Child-Pugh 分级和结石位置相似，但胆管狭窄程度存在显著差异，3D-PTOBF 组胆管狭窄更为常见（ = 0.001）。中位随访时间为 55.0（55.0，512.0）天。3D-PTOBF 组即刻结石清除率（88.6%比 27.1%， = 0.000）和狭窄缓解率（97.1%比 78.6%， = 0.001）显著高于 PTOBF 组。3D-PTOBF 组术后并发症发生率（8.6%比 41.4%， = 0.000）和结石复发率（7.1%比 38.6%， = 0.000）显著低于 PTOBF 组。
3D 可视化有助于使一次性 PTCSL 成为治疗复杂原发性肝内胆管结石安全、有效、有前途的方法。对于复杂原发性肝内胆管结石患者，其围手术期和长期疗效均令人满意。这种微创方法有可能替代肝胆手术。
