Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of recurrent type <b>Ⅱ</b>a hepatolithiasis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

TAN Dengbing ¹ , CHENG Yao ² , GONG Jianping ² ,  PENG Zili ¹

1. Department of General Surgery, Fengjie Branch, The Second Affiliated Hospital of Chongqing Medical University/Fengjie People’s Hospital, Fengjie, Chongqing 404600, P. R. China;
2. Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

PENG Zili, Email: pengzili_2020@sina.com

Keywords：

percutaneous transhepatic choledochoscopic lithotripsy; hepatolithiasis; diffuse hepatolithiasis

DOI：

10.7507/1007-9424.202002086

Video：

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Objective To investigate the feasibility and safety of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent type Ⅱa hepatolithiasis.Methods All of 293 patients with recurrent type Ⅱa hepatolithiasis admitted to the Second Affiliated Hospital of Chongqing Medical University from December 2010 to December 2017 were collected retrospectively, 82 of whom were treated with the PTCSL (PTCSL group), 211 of whom were treated with traditional open surgery (open group). The patients were matched according to the ratio of 1∶1 by using the method of propensity score matching, then the patients were compared after matching.Results A total of 59 pairs were successfully matched, that was, there were 59 patients in the PTCSL group and open group, respectively. Compared with the open group, the PTCSL group had the similar conditions such as the gender, age, preoperative Child-Pugh classification, and times of previous biliary operations, etc. (P>0.050). There was no perioperative death in both groups. There were no significant differences between the two groups in the success rate, operation time, times of operations, time of T tube removal after operation, stone residual rate, and stone recurrence rate (P>0.050). Although the hospital costs of the PTCSL group was higher than that of the open group (P<0.050), the PTCSL group had various advantages, such as less intraoperative bleeding, smaller incisional scar, shorter hospital stay and postoperative ventilation time, and lower rate of total postoperative complications (P<0.050).Conclusions After learning curve, PTCSL has many advantages over traditional open surgery in treatment of recurrent type Ⅱa hepatolithiasis. PTCSL is a minimally invasive surgery, which is safe and effective.

Citation： TAN Dengbing, CHENG Yao, GONG Jianping, PENG Zili. Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of recurrent type Ⅱa hepatolithiasis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(11): 1380-1384. doi: 10.7507/1007-9424.202002086 Copy

1.	中华医学会外科学分会胆道外科学组. 肝胆管结石病诊断治疗指南. 中华消化外科杂志, 2007, 6(2): 156-161.
2.	程南生, 李富宇, 程瑶. 肝胆管结石的外科治疗现状及展望. 中国普外基础与临床杂志, 2014, 21(10): 1185-1188.
3.	Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: A propensity, long-term follow-up analysis at a single center. Surgery, 2018, 163(4): 714-720.
4.	Wang Y, Bo X, Wang Y, et al. Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions. Surg Endosc, 2017, 31(11): 4780-4789.
5.	Suzuki Y, Mori T, Yokoyama M, et al. A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort. J Gastroenterol, 2018, 53(7): 854-860.
6.	Lamanna A, Maingard J, Bates D, et al. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report. J Med Imaging Radiat Oncol, 2019, 63(6): 758-764.
7.	Franzini T, Cardarelli-Leite L, Figueira ERR, et al. SpyGlass percutaneous transhepatic cholangioscopy-guided lithotripsy of a large intrahepatic stone. Endoscopy, 2017, 49(12): E292-E293.
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.	Ogura T, Higuchi K. A review of treatment options for bile duct stones. Expert Rev Gastroenterol Hepatol, 2016, 10(11): 1271-1278.
10.	Takada T, Suzuki S, Nakamura M, et al. Percutaneous transhepatic cholangioscopy as a new approach to the diagnosis of the biliary diseases. Gastroenterol Endosc, 1974, 16(1): 106-111.
11.	Zhang QL, Fujita R, Satake Y. Laser-beam lithotripsy for bile duct stone via percutaneous-transhepatic cholangioscopy. Chin Med J (Engl), 1985, 98(9): 638-642.
12.	Tao H, Wang P, Sun B, et al. One-step multichannel percutaneous transhepatic cholangioscopic lithotripsy applied in bilateral hepatolithiasis. World J Surg, 2020, 44(5): 1586-1594.
13.	Alabraba E, Travis S, Beckingham I. Percutaneous transhepatic cholangioscopy and lithotripsy in treating difficult biliary ductal stones: Two case reports. World J Gastrointest Endosc, 2019, 11(4): 298-307.
14.	刘新文, 程瑶, 龚建平. 经皮经肝胆道镜碎石取石术治疗肝胆管结石的价值. 临床肝胆病杂志, 2019, 35(7): 1640-1643.
15.	Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol, 2006, 20(6): 1075-1083.
16.	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.
17.	韩志敏, 盛银行, 张风奎. 经皮肝胆道镜术两种不同路径治疗复杂肝内外胆管结石的临床疗效比较. 肝胆外科杂志, 2016, 24(6): 422-425.
18.	刘晓洋, 刘晓明, 智绪亭. 两种不同 PTCSL 路径治疗肝胆管结石的临床效果比较. 中国现代普通外科进展, 2015, 18(7): 530-532.
19.	Jeng KS, Sheen IS, Yang FS. Vascular complications in percutaneous transhepatic management of complicated hepatolithiasis with difficult intrahepatic biliary strictures: are they avoidable? Surg Laparosc Endosc Percutan Tech, 2002, 12(2): 82-87.
20.	Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy, 2007, 39(8): 731-736.
21.	何炼图, 汤庆, 陈绮璐, 等. 超声引导在经皮肝胆道镜治疗肝胆管结石中的应用. 中华生物医学工程杂志, 2015, 21(1): 81-83.

1. 中华医学会外科学分会胆道外科学组. 肝胆管结石病诊断治疗指南. 中华消化外科杂志, 2007, 6(2): 156-161.
2. 程南生, 李富宇, 程瑶. 肝胆管结石的外科治疗现状及展望. 中国普外基础与临床杂志, 2014, 21(10): 1185-1188.
3. Chen S, Huang L, Qiu FN, et al. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: A propensity, long-term follow-up analysis at a single center. Surgery, 2018, 163(4): 714-720.
4. Wang Y, Bo X, Wang Y, et al. Laparoscopic surgery for choledocholithiasis concomitant with calculus of the left intrahepatic duct or abdominal adhesions. Surg Endosc, 2017, 31(11): 4780-4789.
5. Suzuki Y, Mori T, Yokoyama M, et al. A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort. J Gastroenterol, 2018, 53(7): 854-860.
6. Lamanna A, Maingard J, Bates D, et al. Percutaneous transhepatic laser lithotripsy for intrahepatic cholelithiasis: A technical report. J Med Imaging Radiat Oncol, 2019, 63(6): 758-764.
7. Franzini T, Cardarelli-Leite L, Figueira ERR, et al. SpyGlass percutaneous transhepatic cholangioscopy-guided lithotripsy of a large intrahepatic stone. Endoscopy, 2017, 49(12): E292-E293.
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. Ogura T, Higuchi K. A review of treatment options for bile duct stones. Expert Rev Gastroenterol Hepatol, 2016, 10(11): 1271-1278.
10. Takada T, Suzuki S, Nakamura M, et al. Percutaneous transhepatic cholangioscopy as a new approach to the diagnosis of the biliary diseases. Gastroenterol Endosc, 1974, 16(1): 106-111.
11. Zhang QL, Fujita R, Satake Y. Laser-beam lithotripsy for bile duct stone via percutaneous-transhepatic cholangioscopy. Chin Med J (Engl), 1985, 98(9): 638-642.
12. Tao H, Wang P, Sun B, et al. One-step multichannel percutaneous transhepatic cholangioscopic lithotripsy applied in bilateral hepatolithiasis. World J Surg, 2020, 44(5): 1586-1594.
13. Alabraba E, Travis S, Beckingham I. Percutaneous transhepatic cholangioscopy and lithotripsy in treating difficult biliary ductal stones: Two case reports. World J Gastrointest Endosc, 2019, 11(4): 298-307.
14. 刘新文, 程瑶, 龚建平. 经皮经肝胆道镜碎石取石术治疗肝胆管结石的价值. 临床肝胆病杂志, 2019, 35(7): 1640-1643.
15. Tazuma S. Gallstone disease: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol, 2006, 20(6): 1075-1083.
16. 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.
17. 韩志敏, 盛银行, 张风奎. 经皮肝胆道镜术两种不同路径治疗复杂肝内外胆管结石的临床疗效比较. 肝胆外科杂志, 2016, 24(6): 422-425.
18. 刘晓洋, 刘晓明, 智绪亭. 两种不同 PTCSL 路径治疗肝胆管结石的临床效果比较. 中国现代普通外科进展, 2015, 18(7): 530-532.
19. Jeng KS, Sheen IS, Yang FS. Vascular complications in percutaneous transhepatic management of complicated hepatolithiasis with difficult intrahepatic biliary strictures: are they avoidable? Surg Laparosc Endosc Percutan Tech, 2002, 12(2): 82-87.
20. Oh HC, Lee SK, Lee TY, et al. Analysis of percutaneous transhepatic cholangioscopy-related complications and the risk factors for those complications. Endoscopy, 2007, 39(8): 731-736.
21. 何炼图, 汤庆, 陈绮璐, 等. 超声引导在经皮肝胆道镜治疗肝胆管结石中的应用. 中华生物医学工程杂志, 2015, 21(1): 81-83.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Value of percutaneous transhepatic choledochoscopic lithotripsy in treatment of recurrent type Ⅱa hepatolithiasis

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