Zhu Canhua, Chen Yanna, Xu Qifeng, Luo Yanjun, Cen Junhua, Wang Guoying
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, No. 151, Yanjiang Rd, Guangzhou, 510120, Guangdong Province, China.
Department of Outpatient and Emergency, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China.
Surg Endosc. 2025 Jul;39(7):4357-4364. doi: 10.1007/s00464-025-11795-1. Epub 2025 May 29.
The electromagnetic tracking system (EMTS) has been increasingly applied in many disciplines. However, its value in percutaneous transhepatic lithotomy has yet to be reported. This study aims to evaluate the clinical application value of an electromagnetic tracking system in assisting with ultrasound-guided percutaneous transhepatic one-step biliary fistulation (PTOBF) combined with rigid choledochoscopy for hepatolithiasis.
The clinical data of 19 patients with hepatolithiasis were analyzed retrospectively. These patients underwent PTOBF combined with rigid choledochoscopy for the treatment of hepatolithiasis.
A total of 19 cases of hepatolithiasis were successfully performed PTOBF combined with rigid choledochoscopy under tracheal intubation and general anesthesia. EMTS-assisted US-guided PTOBF was successfully completed in 18 patients, with a puncture success rate of 94.7% (18/19) and a dilatation success rate of 100.00% (19/19). Five cases percutaneous located in left bile duct while 14 cases in right bile duct, with an overall one-time puncture success rate of 84.2% (16/19). The mean intraoperative blood loss was 6.00 ± 2.63 mL, the mean puncture time was 43.79 ± 65.57 s, and the mean postoperative hospitalization was 4.63 ± 1.86 days. The rates of out-of-plane puncture were 73.7% (14/19), and the initial stone clearance rate was 68.42% (13/19). The incidence of postoperative complications was 10.52% (2/19), including one cases of pleural efusion and one case of bile leakage which recovered after treatment. During a mean follow-up period of 59.26 ± 12.91 days (range 35 to 77 days), no complications or deaths were observed.
EMTS-assisted US guidance for PTOBF combined with rigid choledochoscopy appears to be a minimally invasive, safe, and effective method for the treatment of hepatolithiasis, offering clinical application value. Furthermore, the integration of EMTS and US simplifies and facilitates the operation. Future comparative studies with larger sample sizes are necessary to confirm the reliability of its therapeutic outcomes.
电磁跟踪系统（EMTS）已在许多学科中得到越来越广泛的应用。然而，其在经皮肝穿刺取石术中的价值尚未见报道。本研究旨在评估电磁跟踪系统在辅助超声引导下经皮肝一步法胆管造瘘术（PTOBF）联合硬质胆道镜治疗肝内胆管结石中的临床应用价值。
回顾性分析19例肝内胆管结石患者的临床资料。这些患者均接受了PTOBF联合硬质胆道镜治疗肝内胆管结石。
19例肝内胆管结石患者在气管插管全身麻醉下成功实施了PTOBF联合硬质胆道镜手术。18例患者成功完成了EMTS辅助超声引导下的PTOBF，穿刺成功率为94.7%（18/19），扩张成功率为100.00%（19/19）。5例经皮穿刺位于左肝管，14例位于右肝管，总体一次性穿刺成功率为84.2%（16/19）。术中平均出血量为6.00±2.63ml，平均穿刺时间为43.79±65.57秒，术后平均住院时间为4.63±1.86天。平面外穿刺率为73.7%（14/19），初始结石清除率为68.42%（13/19）。术后并发症发生率为10.52%（2/19），包括1例胸腔积液和1例胆漏，经治疗后痊愈。在平均59.26±12.91天（范围35至77天）的随访期间，未观察到并发症或死亡。
EMTS辅助超声引导下的PTOBF联合硬质胆道镜似乎是一种微创、安全、有效的肝内胆管结石治疗方法，具有临床应用价值。此外，EMTS与超声的整合简化并便利了操作。未来需要更大样本量的比较研究来证实其治疗效果的可靠性。
