关键词: 肝胆管结石, CT三维重建, 经皮经肝穿刺胆道镜取石术, 治疗

Abstract: Objective The aim of this study was to investigate the efficacy of percutaneous transhepatic puncture choledochoscopic lithotomy (PTCSL) under CT three-dimensional reconstruction (3D) guidance in the treatment of patients with complex hepatolithiasis. Methods A total of 136 patients with complicated hepatobiliary stones were admitted to our hospital between June 2018 and June 2020, and 74 patients in observation group were treated by PTCSL under 3D guidance and 62 patients received PTCSL routinely. All patients were followed-up for 12 months. Results The operative time, intraoperative blood loss and hospital stay in the observation group were (98.1±30.2) min, (32.5±10.5) mL and (8.9±1.6) d, significantly shorter or less than [(129.7±36.7) min, (36.9±14.3) mL and (10.8±2.8) d, P< 0.05] in the control group; there were no significant differences as respect to blood biochemical parameters between the two groups (P>0.05); after operation, the incidence of complications in the observation was 4.1%, significantly lower than 14.5%(P＜0.05) in the control; one month after operation, the CT scan showed that the clearance of stone in the observation was 97.3%, significantly higher than 85.5%(P<0.05) in the control; at the end of 12 month followed-up, 5 patients in the observation and 2 patients in the control lost, with the relapse of hepatobiliary stone as demonstrated by CT scan of 2.9%(2/69) and 15.0%(9/60, x²=6.026, P=0.014) in the two groups. Conclusion The PTCSL operation as guided under 3D technology in the treatment of patients with complex hepatolithiasis could improve the stone clearance rate, with reduction of operation time, intraoperative blood loss and hospital stay, which might have a promising efficacy with less residual of stone.

Key words: Hepatolithiasis, CT three-dimensional reconstruction, Percutaneous transhepatic puncture choledochoscopic lithotomy, Therapy