The percutaneous cholangioscopy therapy in treating intra and extra hepatic calculi

ABSTRACT

Objective To study on the percutaneous cholangioscopy therapy in treating intra and extra hepatic calculi and preventing their recurrence. Methods Forty-three patients with biliary tract stones were treated by percutaneous transhepatic cholangioscopy ( PTCS) after percutaneous transhepatic cholan-giostomy, and 22 patients with residual stones installed T-tube more than 3 weeks underwent postoperative cholangioscopy (POCS) therapy. In a total of 65 patients, there were 40 cases of hepatolithiasis ( intrahepat-ic type in 12, intra and extrahepatic type in 28) and 25 cases of choledocholithiasis. Results All sinus tracts of 43 PTCS were dilated up to 19. 1 Fr in mean size before inserting cholangioscopy and the period of establishing sinus tract was in average 17. 1 days. POCS was performed in patients with postoperative placement of T-tube over 3 weeks. Cholangioscopic removal of stones were carried out with basket in 11 cases and electrohydraulic lithotripsy (EHL) in 54 cases due to large or impacted stones, combined with EST with stones extraction in 25 cases. Repeated cholangioscopies were required in 40 cases of IHS with a mean of 5. 2 sessions and 25 cases of choledocholithiasis with an average of 1. 9 sessions per patient until complete stone-extraction. Biliary duct or bilio-enteric anastomotic stricture was dilated with bougienage or balloon dilator in 37 cases; metallic stents were placed at the strictured site in 3 of them. Complete clearance of stones was a-chieved in 64(98. 5% ) patients. Complications of cholangitis occurred in 11 cases and one case of secondary biliary cirrhosis with biliary tract stones died of complicated renal insufficiency when stone extraction was completed. There were no complications associated with the procedure. The rate of stone recurrence was 7. 1% after an average of 30. 8 months follow-up. Conclusion Percutaneous cholangioscopy and EHL are safe and effective techniques for the treatment of biliary tract stones. The use of dilator in treating biliary stricture less than 0. 5cm in length is more effective, it increases clearance rate and decreases recurrent rate.