Ye Yong-Qing, Li Pei-Heng, Ding Zhao-Wei, Zhang Sheng-Feng, Li Rong-Qi, Cao Ya-Wen
Department of Hepatobiliary Surgery, The Second People's Hospital of Foshan, Foshan 528000, Guangdong Province, China.
Department of Oncology, Foshan Nanhai District Fifth People's Hospital, Foshan 528000, Guangdong Province, China.
World J Gastrointest Surg. 2025 Jan 27;17(1):98283. doi: 10.4240/wjgs.v17.i1.98283.
Hepatobiliary stone disease involves an intrahepatic bile duct stone that occurs above the confluence of the right and left hepatic ducts. One-step percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique enables the clearing of intrahepatic stones and the resolution of strictures. However, hepatolithiasis with associated strictures still has high residual and recurrence rates after one-step PTCSL. DynaCT can achieve synchronized acquisition with a flat-panel detector during C-arm rotation. The technical approach and application value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis were evaluated in this study.
To explore the value of DynaCT biliary soft tissue reconstruction technology for the diagnosis and treatment of hepatolithiasis with bile duct stenosis, and to assess the feasibility and effectiveness of the PTOBF technique guided by DynaCT biliary soft tissue reconstruction technology.
The clinical data of 140 patients with complex biliary stenosis disease combined with bile duct stenosis who received PTOBF and were admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to December 2024 were collected. The patients were divided into two groups: DynaCT-PTOBF group (70 patients) and conventional PTOBF group (70 patients). These groups were compared in terms of the preoperative bile duct stenosis, location of the liver segment where the stone was located, intraoperative operative time, immediate stone retrieval rate, successful stenosis dilatation rate, postoperative complication rate, postoperative reoperation rate, stone recurrence rate, and stenosis recurrence rate.
DynaCT biliary soft tissue reconstruction technology was successfully performed in 70 patients. The DynaCT-PTOBF group had a higher detection rate of target bile ducts where bile duct stones and biliary strictures were located than the PTOBF group. Compared with the PTOBF group, the DynaCT-PTOBF group was characterized by a significantly greater immediate stone removal rate (68.6% 50.0%, = 0.025), greater immediate stenosis dilatation success rate (72.9% 55.7%, = 0.034), greater final stenosis release rate (91.4% 75.7%, = 0.012), shorter duration of intraoperative hemorrhage (3.14 ± 2.00 26.5 ± 52.1, = 0.039), and lower incidence of distant cholangitis (2.9% 11.4%, = 0.49). There were no significant differences between the two groups in terms of the final stone removal rate, reoperation rate, or long-term complication incidence rate.
DynaCT biliary soft tissue reconstruction technology guiding the PTOBF technique in patients with hepatolithiasis with bile duct stenosis is feasible and accurate. It may be beneficial for optimizing the preoperative evaluation of the PTOBF technique.
肝胆管结石病是指发生在左右肝管汇合部以上的肝内胆管结石。采用经皮经肝一步法胆瘘（PTOBF）技术的一步法经皮经肝胆道镜碎石术（PTCSL）能够清除肝内结石并解除狭窄。然而，合并狭窄的肝内胆管结石在一步法PTCSL术后仍有较高的残留和复发率。DynaCT能够在C形臂旋转过程中与平板探测器实现同步采集。本研究评估了DynaCT胆道软组织重建技术在诊断和治疗合并胆管狭窄的肝内胆管结石中的技术方法及应用价值。
探讨DynaCT胆道软组织重建技术在诊断和治疗合并胆管狭窄的肝内胆管结石中的价值，并评估在DynaCT胆道软组织重建技术引导下PTOBF技术的可行性和有效性。
收集2020年1月至2024年12月在广州医科大学附属第一医院接受PTOBF治疗且合并胆管狭窄的140例复杂胆管狭窄疾病患者的临床资料。将患者分为两组：DynaCT-PTOBF组（70例）和传统PTOBF组（70例）。比较两组患者术前胆管狭窄情况、结石所在肝段位置、术中手术时间、即时结石清除率、狭窄扩张成功率、术后并发症发生率、术后再次手术率、结石复发率和狭窄复发率。
70例患者成功实施DynaCT胆道软组织重建技术。DynaCT-PTOBF组胆管结石和胆管狭窄所在目标胆管的检出率高于PTOBF组。与PTOBF组相比，DynaCT-PTOBF组的即时结石清除率显著更高（68.6%对50.0%，P = 0.025），即时狭窄扩张成功率更高（72.9%对55.7%，P = 0.034），最终狭窄解除率更高（91.4%对75.7%，P = 0.012），术中出血持续时间更短（3.14±2.00对26.5±52.1，P = 0.039），远处胆管炎发生率更低（2.9%对11.4%，P = 0.49）。两组在最终结石清除率、再次手术率或长期并发症发生率方面无显著差异。
DynaCT胆道软组织重建技术在合并胆管狭窄的肝内胆管结石患者中引导PTOBF技术是可行且准确的。这可能有利于优化PTOBF技术的术前评估。
