Clinical effective analysis of percutaneous transhepatic cholangioscopic lithotrip by rigid choledochoscopy for 194 patients with intrahepatic stones

doi:10.19538/j.cjps.issn1005-2208.2017.08.16

Abstract：Objective To investigate the clinical application of percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for intrahepatic stones. Methods The clinical data of 194 patients with complicate intrahepatic stone performed PTCSL between February 1, 2008 and December 31, 2016 in Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Guangzhou Medical University were analyzed retrospectively. The procedure was divided into two groups: one step procedure percutaneous transhepatic cholangial drainage and percutaneous transhepatic cholangioscopy were performed simultaneously; Two step procedure percutaneous transhepatic cholangioscopy was performed 3-5 days after percutaneous transhepatic cholangial drainage. Results All the patients were successfully performed by percutaneous transhepatic cholangioscopy. The one step procedure was performed in 28 patients(14.4%), while two step procedure 166 patients(85.6%). Operation time was(45.0 ± 8.0)min. Saline solution used for rinse was (6000.0±500.0)mL. The stone clearance status:intrahepatic stones were all removed in 81 patients(41.8%). Incomplete removal was achieved in 113 patients (58.2%), of which 109 patients of secondary bile duct branch without residual stones. Postoperative complications included 13 patients(6.7%)with biliary tract infection and 5 patients(2.6%)with bleeding. Two patients developed into infection shock and one patient died of multiple organ failure. One hundred and sixty-tow patients (83.5%) were followed up, and the overall recurrence rate for hepatolithiasis in patients who underwent PTCS therapy was 29.6%(48/162). Conclusion PTCSL is effective in the treatment of selected patients with intrahepatic bile duct stones. Combination of stiff and soft cholangioscopy can reduce the possibility of retaining stones after operation. Compared with one step procedure, two step procedure may result in fewer serious complications.