Clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation for the treatment of hepatolithiasis / 中华消化外科杂志

ABSTRACT

Objective:To investigate the clinical efficacy of percutaneous transhepatic cholangioscopic lithotripsy with one-step biliary fistulation (PTCSL-OBF) for the treatment of hepatolithiasis.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 59 patients with hepatolithiasis who were admitted to the First Affiliated Hospital of Nanjing Medical University from March 2017 to December 2019 were collected. There were 16 males and 43 females, aged from 16 to 84 years, with a median age of 60 years. All patients underwent PTCSL-OBF. Observation indicators (1) surgical and postoperative situations; (2) follow-up; (3) introduction of special cases. Follow-up using outpatient examination and telephone interview was performed to detect the hepotolithiasis-related symptoms, recurrence of hepatolithiasis , and survival of patients up to December 2019. Measurement data with skewed distribution were represented as M (range). Count data were represented as absolute numbers or percentages. Results:(1) Surgical and postoperative situations 59 patients underwent PTCSL-OBF successfully. Of the 59 patients, 48 cases had 1 biliary sinus tract, 8 cases had 2 biliary sinus tracts, 2 cases had 3 biliary sinus tracts and 1 case had 4 biliary sinus tracts. A total of 106 times of cholangioscopic lithotripsy procedure were performed in the 59 patients, including 20 cases with once of cholangioscopic lithotripsy procedure, 31 cases with twice of cholangioscopic lithotripsy procedure and 8 cases with 3 times of cholangioscopic lithotripsy procedure. Among the 59 patients, 14 cases were diagnosed with residual stones after operation, 45 cases had stones removed completely with the stones removal rate of 76.3%(45/59). The duration of hospital stay of the 59 patients were 24 days(range, 3-88 days). Of the 59 patients, 11 cases had 14 times of postoperative complications. The total incidence of complications was 18.6%(11/59). Among the 14 times of complications, there were 4 times of pleural effusion combined with infection, 2 times of liver abscess, 2 times of ascites, 2 times of intraoperative hypotension septic shock, 2 times of bleeding, 1 time of colon perforation and 1 time of bile leakage. Patients with complications were cured with symptomatic support treatment including puncture drainage, anti-infection and hemostasis. (2) Follow-up 59 patients were followed up for 1-34 months, with a median follow-up time of 18 months. Of the 59 patients, 9 had recurrence of hepatolithiasis, with a recurrence rate of 15.3%(9/59); 17 had hepatolithiasis related symptoms, with an incidence of 28.8%(17/59). Of the 45 patients who had stones removed completely, 6 had recurrence of hepatolithiasis, with a recurrence rate of 13.3%(6/45); 14 had hepatolithiasis related symptoms, with an incidence rate of 31.1%(14/45). Of the 14 patients who had residual stones postoperatively, 3 had recurrence of hepatolithiasis, with an incidence rate of 21.4%(3/14); 3 had hepatolithiasis related symptoms, with an incidence rate of 21.4%(3/14). During the follow-up, 7 of 59 patients died, 2 of whom died of biliary neoplasms and 5 died of decompensated cirrhosis. (3) Introduction of special cases among the 5 patients with biliary cirrhosis, 3 cases had stones removed completely, but the original symptoms of the 2 cases were not improved postoperatively and cholangitis occurred repeatedly. The other 2 cases underwent only once of cholangioscopic lithotripsy procedure because of severe cirrhosis combine with massive ascites.Conclusion:PTCSL-OBF can be used in the treatment of hepatolithiasis with appropriate indications, careful operation and strengthened perioperative management to reduce complications.