ABSTRACT
Objective To evaluate the clinical value of percutaneous transhepaticcholangioscopic lithotomy (PTCSL)combined with rigid cholangioscopy in treatment of recurrent hepatolithiasis. Methods Retrospective analysisof therapeutic result of 54 patientswith postoperative recurrent hepatolithiasisduring January 2012 to January 2015. Twenty eight cases were recruited as the observation group (PTCSL group). Twenty six cases were recruited as the control group (Laparotomy group). Following parameters were observed, operation time, intraoperative blood loss, clearance of stones and postoperative hospital stay. Results The operation time, intraoperative blood loss , clearanceof stones , and the postoperative hospital stay of the PTCSL group werebetter than that of the laparotomy group (P<0.05). The number of patients with postoperative pain of the PTCSL group was significantly lower than in the laparotomygroup (P<0.05). There were no significant differences in other complication rates. There was no difference in terms of stone recurrence , incidence of cholangitis and intrahepatic biliary strictures recurrence ratebetween two groups in follow-up period. Conclusions PTCSL combined with rigid choledochoscopywas a safe and effectivemethod with minimal invasion formanagement of the postoperative recurrent hepatolithiasis. It could got a better resultsin the short-term outcomes.
ABSTRACT
BACKGROUND/AIMS: Approximately 5% to 10% of common bile duct (CBD) stones are difficult to remove by conventional endoscopic methods. Percutaneous transhepatic cholangioscopic lithotomy (PTCSL) can be an alternative method for this condition, but is not well established yet. The aim of this study was to evaluate the clinical efficacy and safety of PTCSL for removal of difficult CBD stones. METHODS: This study is a retrospective review of 34 consecutive patients who underwent unsuccessful removal of CBD stones using conventional endoscopic methods between December 2008 and July 2010 and were subsequently treated using PTCSL. RESULTS: Among 443 patients with CBD stones, 34 patients (7.8%) failed to achieve stone removal using conventional endoscopic methods. Of these 34 patients, 33 were treated using PTCSL. In all 33 cases (100%), complete stone removal was achieved using PTCSL. Most complications (15/17, 88.2%) were mild and transient. Major complications occurred in two patients (6.1%) who experienced hemobilia, and percutaneous transhepatic biliary drainage tract disruption, respectively; which were fully recovered without mortality. CONCLUSIONS: Despite prolonged hospital stay and temporary decline of quality of life, PTCSL is an effective and safe method in the management of difficult CBD stones, especially in patients with difficulty in approaching the affected bile duct.
Subject(s)
Humans , Bile Ducts , Common Bile Duct , Drainage , Hemobilia , Length of Stay , Quality of Life , Retrospective StudiesABSTRACT
BACKGROUND/AIMS: Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS. METHODS: Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively. RESULTS: Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p<0.05). The number of sessions of PTCS was 2.7+/-0.3, 3.9+/-0.3, and 2.7+/-0.5 respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups. CONCLUSIONS: A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS.
Subject(s)
Humans , Bile Ducts, Intrahepatic , Constriction, Pathologic , Factor IX , Retrospective StudiesABSTRACT
PURPOSE: Percutaneous Transhepatic Cholangioscopic Lithotomy (PTCS-L) has been reported as an effective and safe therapeutic method for complicated hepatobiliary stones, particularly in high risk patients. However, there were some limitations and technical difficulties encountered in PTCS-L. The purpose of this retrospective study was to assess the result of PTCS-L in patients with recurrent or residual hepatobiliary stones. METHODS: The medical records of 61 consecutive patients (Jan.1997~Jun.2002) treated with PTCS-L for biliary stone were reviewed. There were 29 patients with primary treatment, and 32 patients with adjuvant treatment for residual stones. PTCS-L was performed within 2 weeks following progressive exchange of PTCS catheter after PTBD. Lithotomy was combined with either electrohydraulic lithotripsy (EHL), Dormia basket, or saline irrigation under fluroscopic guide. If stone was free on one or two consecutive cholangiography after final session lithotomy, then PTCS catheter was removed, but in cases of biliary stricture, 20Fr. of PTCS catheter was placed for average 71 (ranged; 27~270) days. RESULTS: Locations of stones were intrahepatic duct (IHD) in 22 cases, common bile duct (CBD) in 22 cases, CBD & IHD in 11 cases, cystic duct stump & CBD in 3 cases, GB in 2 cases and GB & CBD in 1 case. Routes for PTCS-L were of Rt. hepatic approach (B5 or B6) in 15 cases, Lt. hepatic approach (B3) in 42 cases, both hepatic approach in 2 cases and percutaneous gallbladder drainage (PGBD) tract in 2 cases. Sessions of PTCS-L were one in 22 cases, two in 26 cases, three in 9 cases and four in 4 cases, and overall in 1.5 session. Causes of multiple session in 39 cases were biliary stricture in 13 cases (33%), impacted stones in 10 cases (26%), large stone (>2 cm) in 9 cases (23%) and anatomical variation of IHD including severe ductal angulation in 7 cases (18%), which necessitated routine combined use of EHL (total 44 cases) and sometimes fluroscopic lithotomy (3 cases). Complications encountered following PTCS-L were transient hemobilia in 11 cases, catheter dislodgement in 1 case and hepatic abscess in 1 case, but mortality was nil. During followed up of median 17 months (1~53 months), recurrence of stone occurred in 1 case and one among of 13 patients with biliary stricture underwent operation on recurred biliary stricture. CONCLUSION: PTCS-L is very useful alternative treatment to surgery for residual or recurrent stones and is highly indicated for those of high risk patients. However, Electrohydraulic lithotripsy (EHL) should be combined for those of patients with technical difficulties encountered in case of multiple large impacted stones particularly in the strictured and angulated intrahepatic ducts.