RÉSUMÉ
Objective:To evaluate the curative effect of percutaneous transhepatic choledoscopy (PTCS) in the treatment of complex intrahepatic and extrahepatic bile duct stones.Methods:Clinical data of 120 patients with complex intrahepatic and extrahepatic bile duct stones admitted to Baiyin Second People's Hospital from January 2021 to December 2021 were retrospectively analyzed, including 74 males and 46 females, aged (53.3±2.4) years old. Patients were divided the control group ( n=60) who underwent routine laparotomy and the observation group ( n=60) who underwent PTCS. Perioperative outcomes, including the intraoperative blood loss, operation time, postoperative exhaust time, stress status, liver function index [serum level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] and postoperative complications of the two groups were compared. Results:Compared with the control group, the observation group had a shorter operation time [(1.62±0.24) h vs. (2.35±0.28) h] and postoperative exhaust time [(1.80±0.25) d vs. (2.53±0.28) d], and a decreased intraoperative blood loss [(51.21±8.23) ml vs. (119.21±8.29) ml] (all P<0.05). The serum levels of adrenaline [(119.7±12.0) ng/ml vs. (130.5±14.2) ng/ml], ALT [(70.02±2.42) U/L vs. (87.30±2.56) U/L] and AST [(188.6±24.7) U/L vs. (201.7±28.5) U/L] were lower in observation group one day after surgery (all P<0.05). The total effective rate in observation group was higher than that in control group [96.7%(58/60) vs. 83.3%(50/60), P=0.005]. The rate of complications was also lower in observation group [6.7%(4/60) vs. 36.7%(22/60), P=0.005]. Conclusion:Compared to routine laparotomy, PTCS could be more feasible for complex intra- and extrahepatic bile duct stones, considering its minimal invasiveness, less stress reaction, enhanced postoperative recovery, less disturbance of liver function, and decreased complications.
RÉSUMÉ
El interés en la coledoscopia se ha incrementado por la aparición de nuevos equipos de videoendoscopia electrónica de diámetro muy delgado dotados de microchips que proveen mejores imágenes (CCD). Se presenta nuestra experiencia inicial con el uso de un endoscopio ultradelgado para la visualización del hepatocolédoco. Se empleó un nasofibroscopio ultradelgado Fujinon EG-530N de 5,9 mms de diámetro (EG530N, Fujinon-Toshiba, Tokyo, Japón). Se presentan 7 casos en los que se practicó con este equipo una coledocoscopia con fines diagnósticos. Fue posible detectar la presencia de litiasis residual después de procedimientos endoscópicos para extraer cálculos en dos pacientes, confirmar la ausencia de cálculos en otros 3, diagnosticar mediante biopsia guiada por coledoscopia la naturaleza de una lesión estenosante a nivel del hilio hepático (adenoma tubular) y precisar la causa de disfunción de una prótesis biliar metálica autoexpandible. 1. Se presenta nuestra experiencia inicial con coledoscopia practicada con un videoendoscopio ultradelgado. 2. Se discuten las indicaciones del procedimiento y las complicaciones eventuales del mismo. 3. Se demuestra la factibilidad del procedimiento y la utilidad del mismo en el manejo de patología biliar
The interest with choledoscopy has been increased with the new videoendoscopy instruments of very small diameter provided with microchips which give better images (CCD). Patients and methods: a nasofiberscope, 5.9 mm diameter (EG530N, Fujinon-Toshiba, Tokyo, Japan) was utilized. We present 7 cases studied with choledoscopy performed with this instrument for diagnostic purposes. It was possible to detect residual lithiasis after endoscopic procedures for the extraction of biliary stones in two cases, to confirm the absence of stones in other three cases, to diagnose with choledoscopy-guided biopsy the presence of a stenosing lesion at the hepatic hilum (tubular adenoma) and to precise the cause of dysfunction of a self-expandable metal stent. 1. Our initial experience with choledoscopy performed with a small caliber videoendoscope is presented. 2. The indications and eventual complications of the procedure are discussed. 3. The feasibility of the procedure and its application in the management of biliary pathology is demonstrated