Effectiveness and safety analyses of electronic choledochoscopy in treatment of intrahepatic bile duct stones_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 YANG Guochun , CHEN Honggang , LIU Qifei , LIU Hongyan , ZHAO Qin

Department of Emergency Surgery, Affiliated Hospital of Shandong Academy of Medical Sciences, Jinan 250031, P.R.China;

Corresponding author：

YANG Guochun, Email: yangguochun25@yeah.net

Keywords：

electronic choledochoscopy; intrahepatic bile duct stone; effectiveness; safety

DOI：

10.7507/1007-9424.201612020

Video：

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Objective To evaluate effectiveness and safety of electronic choledochoscopy in treatment of intrahepatic bile duct stones. Methods From July 2013 to February 2016, 280 patients with intrahepatic bile duct stones in the Department of General Surgery of the Affiliated Hospital of Shandong Academy of Medical Sciences were selected as the research objects. All the patients were randomly divided into a choledochoscopy treatment group and a conventional treatment group by envelope principle method. There were 140 patients in each group. The safety and short- and long-term effectiveness were compared in these two groups. This study was approved by the ethics committee of the hospital. Results ① The age, gender, body mass index, course of disease, and location of stone had no significant differences in these two groups (P>0.05). ② The operations and the net stones were successfully completed in all the patients. The operative time was shorter, the blood loss was less, the incision length was smaller, the postoperative anal exhaust time was earlier, and the hospitalization time was shorter in the choledochoscopy treatment group as compared with the conventional treatment group (P<0.05). ③ The total postoperative complication rate on day 14 in the choledochoscopy treatment group was 2.9% (4/140), which was significantly lower than that in the conventional treatment group (11.4%, 16/140, P<0.05). ④ The curative excellent and good rates was 97.9% and 85.0% in the choledochoscopy treatment group and conventional treatment group respectively, which was a significant difference in these two groups (P<0.05). ⑤ The postoperative serum ALT and AST values on month 6 in the choledochoscopy treatment group were significantly lower than those in the conventional treatment group (P<0.05). Conclusion Electronic choledochoscopy in treatment of intrahepatic bile duct stones could promote rehabilitation of patient, reduce incidence of postoperative complications, and it is conducive to promoting recovery of liver function and improving follow-up effect.

Citation： YANG Guochun, CHEN Honggang, LIU Qifei, LIU Hongyan, ZHAO Qin. Effectiveness and safety analyses of electronic choledochoscopy in treatment of intrahepatic bile duct stones. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(8): 987-991. doi: 10.7507/1007-9424.201612020 Copy

1.	苏生蔼. 肝内胆管结石的外科治疗措施综合疗效分析. 中国实用医刊, 2016, 43(3): 34-35.
2.	陈忠尧, 周钱江, 袁建南, 等. 肝叶、段切除治疗肝内胆管结石 52 例分析. 浙江医学, 2016, 38(12): 1013-1015.
3.	Yokoyama K, Hatanaka H, Inoue M, et al. Multiple orifices and cholangiography with a " fire-like” appearance after Kasai hepatoportoenterostomy for biliary atresia. J Pediatr Surg, 2016, 51(9): 1574-1576.
4.	徐勇士, 刘义武, 凌晓明. 腹腔镜和胆道镜治疗高龄胆囊合并胆总管结石分析. 中华普外科手术学杂志(电子版), 2016, 4(1): 70-72.
5.	石电威. 腹腔镜联合胆道镜治疗胆结石的疗效分析. 临床医药文献电子杂志, 2016, 3(18): 3597-3597, 3599.
6.	李新丰, 王伟, 王高雄, 等. 腹腔镜联合胆道镜体内碎石治疗老年人肝外胆道结石. 中华诊断学电子杂志, 2015, 16(3): 221.
7.	Lee CF, Lee WC, Wu RC, et al. Intrahepatic duct stones harboring ascariasis ova: A case report. Medicine (Baltimore), 2016, 95(12): e3139.
8.	Cannavale A, Bezzi M, Cereatti F, et al. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience. Therap Adv Gastroenterol, 2015, 8(6): 340-351.
9.	Clemente G, De Rose AM, Murri R, et al. Liver resection for primary intrahepatic stones: focus on postoperative infectious complications. World J Surg, 2016, 40(2): 433-439.
10.	Xu G, Wen J, Wang B, et al. The clinical efficacy and safety of ureteroscopic laser papillotomy to treat intraductal papillary calculi associated with medullary sponge kidney. Urology, 2015, 86(3): 472-476.
11.	徐恕, 张剑权, 符国珍, 等. 经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石的近远期疗效. 中华普通外科杂志, 2016, 31(3): 212-214.
12.	Zhang R, Luo H, Pan Y, et al. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination. Gastrointest Endosc, 2015, 82(4): 660-665.
13.	陈永标, 池小斌, 江艺, 等. 腹腔镜肝切除联合胆道镜治疗肝内外胆管结石 36 例. 中国微创外科杂志, 2016, 16(9): 777-779.
14.	Yang YL, Zhang C, Zhao G, et al. Choledochoscopic high-frequency needle-knife electrotomy as an effective treatment for intrahepatic biliary strictures. J Gastroenterol Hepatol, 2015, 30(9): 1438-1443.
15.	Shin YC, Jang JY, Kang MJ, et al. Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc, 2016, 30(1): 259-265.
16.	骆伟, 孟文勃, 岳平, 等. 胆肠吻合术后胆管结石复发的内镜外科治疗进展. 中华消化内镜杂志, 2016, 33(2): 130-133.
17.	Lee JH, Kim HW, Kang DH, et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones. Clin Endosc, 2013, 46(1): 65-70.
18.	Wang P, Sun B, Huang B, et al. Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 54-59.
19.	Ma S, Hu S, Gao F, et al. Endoscopy lithotomy for intrahepatic gallstones: a meta-analysis. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): 269-274.
20.	Kim YK, Han HS, Yoon YS, et al. Laparoscopic approach for right-sided intrahepatic duct stones: a comparative study of laparoscopic versus open treatment. World J Surg, 2015, 39(5): 1224-1230.
21.	Dong CC, Fang CH, Wu TC, et al. Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique. Hepatogastroenterology, 2014, 61(134): 1556-1562.
22.	Kassem MI, Sorour MA, Ghazal AH, et al. Management of intrahepatic stones: the role of subcutaneous hepaticojejunal access loop. A prospective cohort study. Int J Surg, 2014, 12(9): 886-892.
23.	杨晓平, 王平, 蔡阳, 等. 肝切除术治疗肝内胆管结石伴胆道出血. 浙江临床医学, 2016, 18(5): 863-864.

1. 苏生蔼. 肝内胆管结石的外科治疗措施综合疗效分析. 中国实用医刊, 2016, 43(3): 34-35.
2. 陈忠尧, 周钱江, 袁建南, 等. 肝叶、段切除治疗肝内胆管结石 52 例分析. 浙江医学, 2016, 38(12): 1013-1015.
3. Yokoyama K, Hatanaka H, Inoue M, et al. Multiple orifices and cholangiography with a " fire-like” appearance after Kasai hepatoportoenterostomy for biliary atresia. J Pediatr Surg, 2016, 51(9): 1574-1576.
4. 徐勇士, 刘义武, 凌晓明. 腹腔镜和胆道镜治疗高龄胆囊合并胆总管结石分析. 中华普外科手术学杂志(电子版), 2016, 4(1): 70-72.
5. 石电威. 腹腔镜联合胆道镜治疗胆结石的疗效分析. 临床医药文献电子杂志, 2016, 3(18): 3597-3597, 3599.
6. 李新丰, 王伟, 王高雄, 等. 腹腔镜联合胆道镜体内碎石治疗老年人肝外胆道结石. 中华诊断学电子杂志, 2015, 16(3): 221.
7. Lee CF, Lee WC, Wu RC, et al. Intrahepatic duct stones harboring ascariasis ova: A case report. Medicine (Baltimore), 2016, 95(12): e3139.
8. Cannavale A, Bezzi M, Cereatti F, et al. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience. Therap Adv Gastroenterol, 2015, 8(6): 340-351.
9. Clemente G, De Rose AM, Murri R, et al. Liver resection for primary intrahepatic stones: focus on postoperative infectious complications. World J Surg, 2016, 40(2): 433-439.
10. Xu G, Wen J, Wang B, et al. The clinical efficacy and safety of ureteroscopic laser papillotomy to treat intraductal papillary calculi associated with medullary sponge kidney. Urology, 2015, 86(3): 472-476.
11. 徐恕, 张剑权, 符国珍, 等. 经皮肝穿刺胆管造瘘电子胆道镜取石术治疗肝内胆管结石的近远期疗效. 中华普通外科杂志, 2016, 31(3): 212-214.
12. Zhang R, Luo H, Pan Y, et al. Rate of duodenal-biliary reflux increases in patients with recurrent common bile duct stones: evidence from barium meal examination. Gastrointest Endosc, 2015, 82(4): 660-665.
13. 陈永标, 池小斌, 江艺, 等. 腹腔镜肝切除联合胆道镜治疗肝内外胆管结石 36 例. 中国微创外科杂志, 2016, 16(9): 777-779.
14. Yang YL, Zhang C, Zhao G, et al. Choledochoscopic high-frequency needle-knife electrotomy as an effective treatment for intrahepatic biliary strictures. J Gastroenterol Hepatol, 2015, 30(9): 1438-1443.
15. Shin YC, Jang JY, Kang MJ, et al. Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc, 2016, 30(1): 259-265.
16. 骆伟, 孟文勃, 岳平, 等. 胆肠吻合术后胆管结石复发的内镜外科治疗进展. 中华消化内镜杂志, 2016, 33(2): 130-133.
17. Lee JH, Kim HW, Kang DH, et al. Usefulness of percutaneous transhepatic cholangioscopic lithotomy for removal of difficult common bile duct stones. Clin Endosc, 2013, 46(1): 65-70.
18. Wang P, Sun B, Huang B, et al. Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment. Surg Laparosc Endosc Percutan Tech, 2016, 26(1): 54-59.
19. Ma S, Hu S, Gao F, et al. Endoscopy lithotomy for intrahepatic gallstones: a meta-analysis. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): 269-274.
20. Kim YK, Han HS, Yoon YS, et al. Laparoscopic approach for right-sided intrahepatic duct stones: a comparative study of laparoscopic versus open treatment. World J Surg, 2015, 39(5): 1224-1230.
21. Dong CC, Fang CH, Wu TC, et al. Management complicated hepatolithiasis with operative rigid choledochoscope guided by computed tomography (CT)-based 3D reconstruction technique. Hepatogastroenterology, 2014, 61(134): 1556-1562.
22. Kassem MI, Sorour MA, Ghazal AH, et al. Management of intrahepatic stones: the role of subcutaneous hepaticojejunal access loop. A prospective cohort study. Int J Surg, 2014, 12(9): 886-892.
23. 杨晓平, 王平, 蔡阳, 等. 肝切除术治疗肝内胆管结石伴胆道出血. 浙江临床医学, 2016, 18(5): 863-864.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Effectiveness and safety analyses of electronic choledochoscopy in treatment of intrahepatic bile duct stones

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