Percutaneous transhepatic cholecystoscopy in treating cholecystolithiasis / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the significance of percutaneous transhepatic cholecystoscopy ( PTCCS) in managing cholecystolitheasis. Methods From September 1999 to November 2001, eighty - six patients with symptomatic gallstones were allocated into this study. At first percutaneous transhepatic gallbladder drainage ( PTGBD) was carried out, one week later the formed fistula was dilated by bouginage to 16-22Fr in diameter, thereafter cholecystoscope was inserted into gallbladder through the dilated fistula to extract the stones using basket or electrohydraulic lithotripsy (EHL). Results PTGBD was attempted successfully in 82 out of 86 cases, PTCCS was performed in 80 of them. The amount of stones ranged from 1 to 76, single stone in 28 patients, stones more than two in 52 , with stone size ranged from 5 to 32 mm, and stones greater than 15mm in 45 cases. The stones were removed only using basket in 28, and by EHL in 54 cases due to their large size. The overall stone removal rate was 97. 5 % (78/80) . Complication of peritonitis appeared in 4 cases (4. 7% ) requiring emergent surgical intervention. The follow - up period with an average of 16. 4 months, gallstones recurred in 2 cases (2.5%). Stones were assayed by intra - red spectrom-etry in 30 of 54 patients with EHL, cholesterol stone existed in 24 of them. Conclusion PTCCS is relatively a safe and effective procedure for those patients with high risk on surgical cholecystectomy, or unsuitable to receive laparoscopic cholecystectomy. If the patients were selected strictly along the rules of indication, the complication and stone recurrence can be avoided.