CT引导下经皮肝穿刺胆道镜联合双频激光碎石取石治疗复发性肝内胆管结石患者疗效及安全性分析*

doi:10.3969/j.issn.1672-5069.2022.01.027

Abstract

Abstract: Objective The aim of this clinical observation was to investigate the efficacy and safety of CT-guided percutaneous transhepatic choledochoscopic lithoteipsy (PTCSL) and dual-frequency laser lithotripsy (DFLL) combination in the treatment of patients with recurrent hepatolithiasis. Methods A total of 60 patients with recurrent hepatolithiasis were admitted to our hospital between September 2017 and February 2020, and 31 patients in group A received CT-guided PTCSL and DFLL and 29 patients in group B underwent open choledochofiberscope and DFLL. Serum cortisol (COR) and epinephrine (EP) were detected. Results The operation time, exhaust time, first defecation time and postoperative hospitalization stay in group A were(89.7±10.1)min, (30.3±3.6)h, (2.3±0.3)d and (6.9±1.1)d, all significantly shorter than [(101.9±12.2)min, (34.7±4.1)h, (2.7±0.4)d and (11.8±1.6)d, respectively, P＜0.05], while blood loss was (40.2±8.8)ml, much less than [(97.4±10.6)ml, P＜0.05] in group B; at the end of seven days after operation, the white blood cell counts, neutrophil percentage, serum COR and EP levels were (9.7±1.0)×10⁹/L, (67.8±5.9)%, (310.1±30.7)mmol/L and (210.7±22.8)pg/mL, significantly lower than [(11.8±1.3)×10⁹/L, (76.4±7.1)%, (385.5±34.4)mmol/L and (247.3±23.1), respectively, P＜0.05] in group B; serum ALT, AST, ALP and bilirubin level were (39.7±3.7)U/L, (39.9±4.1)U/L, (80.1±8.5) and (19.4±1.8)μmol/L, significantly lower than [(45.6±5.1)U/L, (45.5±5.1)U/L, (85.9±6.8) and (23.0±3.4), respectively, P＜0.05] in group B; the incidence of postoperative complications was 9.7%, significantly lower than 41.4% (P<0.05) and the stone residual rate was 6.5%, significantly lower than 31.0% in group B(P＜0.05). Conclusion CT-guided (PTCSL) and DFLL combination could reduce surgical damage, accelerate postoperative recovery of gastrointestinal functions with low stone residual rate, which might be related to less oxidative stress and inflammatory reaction.

Key words: Hepatolithiasis, Percutaneous transhepatic cholangioscopic lithotomy, Dual-frequency laser lithotripsy, Efficacy

Wang Ling, Wei Zhili, Song Pinghui. Efficacy and safety of CT-guided percutaneous transhepatic choledochoscopy and dual-frequency laser lithotripsy combination in the treatment of patients with recurrent hepatolithiasis[J]. Journal of Practical Hepatology, 2022, 25(1): 108-111.

References

[1] Yamamoto R, Abe T,Hosaka S, et al. Intrahepatic bile duct stone treatment combining electrohydraulic lithotripsy and peroral cholangioscopy through a choledochoduodenal fistula.Endoscopy,2019,51(10):E290-E292.
[2] Ma Z, Zhao F, Pan J, et al. Cysticintraductal papillary neoplasms with infiltrating carcinoma of the intrahepatic bile duct: A case report. Medicine, 2020,99(3):e18758.
[3] Zhuo H, Chen ZM, Lin RZ, et al. Percutaneous transhepatic choledochoscopic lithotomy is effective for the treatment of intrahepatic and extrahepaticcholedocholithiasis. Surg Laparo Endo Per, 2020, 37(10):874-876.
[4] Hao J, Jinrui F, Wei L, et al. Percutaneous transhepatic cholangioscopic lithotripsy using soft fiber-optic choledochoscope. Z Gastroenterol, 2019,57(10):1196-1199.
[5] 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.
[6] 张帆,刘瑾,杨海马.双频激光干涉仪互补校准式高精度位移检测系统研究.传感器与微系统,2020,39(3):14-17.
[7] HanCS,Vetter JM, Endicott R, et al. Dual-frequency setting for urinary stone fragmentation during shock wave lithotripsy: an in vitro study. Urolithiasis, 2020,48(5):1162-1164.
[8] Masayuki A, Tetsuo A, Takumi F, et al. Keratin 19-expressing hepatocellular carcinoma and small-duct type intrahepatic cholangiocarcinoma show a similar post-operative clinical course but have distinct genetic features. Histopathology, 2019,75(3):385-393.
[9] Yang J, Tao H,Luo W, et al. A novel method of fluorescent imaging can guide hepatectomy for intrahepatic cholangiocarcinoma with intrahepatic biliary obstruction. J Surg Oncol, 2020,122(8):204-208.
[10] 许彦,黄丽芳,曾鸿孟,等.肝内胆管结石术后复发的研究进展.重庆医学,2020,49(20):3476-3480.
[11] Enikeev D, Taratkin M S, Klimov R, et al. Superpulsed thulium-fiber laser for stone dusting - in search of perfect ablation regimen. A prospective single center study. J Endourol, 2020,34(11):519.
[12] 陈武业,方永平,李坤平,等.经皮经肝穿刺一期硬质胆道镜取石术治疗肝内胆管结石的疗效分析.中华普通外科杂志,2019,34(1):68-69.
[13] KimSJ, Akita M, Sung YN, et al. MDM2 Amplification in intrahepatic cholangiocarcinomas: Its relationship with large-duct type morphology and uncommon KRAS mutations. Am J Surg Pathol, 2018, 42(4):1.
[14] Hubers J, Patel R, Dalvie P, et al. Percutaneous transhepatic cholangioscopy with electrohydraulic lithotripsy in a patient with choledocholithiasis in a metal biliary stent. Am J Gastroenterol,2018,113(15):S832-S833.
[15] ChoiCW, Kang DH, Kim HW, et al. PTCSL for removal of bile duct stones in Billroth II gastrectomy patients who are difficult to perform ERCP. Gastrointest Endosc, 2010, 71(5):A308.
[16] 陈佳骏,张海阳,曹学冬,等.不同手术方法治疗肝内胆管结石的疗效对比与危险因素分析.中国现代普通外科进展,2020,23(2):113-117.
[17] 马信奎,刘勇,张伟.经皮经肝胆道镜硬镜碎石术治疗肝内胆管结石患者临床疗效研究.实用肝脏病杂志,2019,22(4):593-596.
[18] 吴琛,张龙,游伟,等.超声融合成像导航系统在经皮肝穿刺胆道镜取石术中的临床应用价值.中华肝胆外科杂志,2020,26(5):364-368.
[19] Lange U,Dischereit G. High resolution cholangioscopic electrohydraulic lithotripsy for fragmentation and extraction of impacted cystic duct stones. Endoscopy, 2016, 48(1):E88-E89.
[20] Wang P,Beiwang S,Zixuan Z,et al. Comparison between percutaneous transhepatic rigid cholangioscopic lithotripsy and conventional percutaneous transhepatic cholangioscopic surgery for hepatolithiasis treatment. Surg Laparo Endo Per, 2016,26(1):.54-59.

Efficacy and safety of CT-guided percutaneous transhepatic choledochoscopy and dual-frequency laser lithotripsy combination in the treatment of patients with recurrent hepatolithiasis

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[10]	Ding Jie,Li Tao,Xu Yiming, et al. Pre-operational three-dimensional visualization technology by CT scan in guiding operation in patients with complex hepatolithiasis [J]. Journal of Practical Hepatology, 2021, 24(1): 139-142.
[11]	Diao Qing, Duan Yinhuan, Miao Liang, et al. Efficacy and safety of direct acting antiviral agents in the treatment of patients with hepatitis C cirrhosis [J]. Journal of Practical Hepatology, 2020, 23(6): 841-844.
[12]	Zhang Jing, Guo Changcun. Outcomes of ultrasound-guided percutaneous microwave ablationby Milan criteria for the treatment of patients with hepatocellular carcinoma [J]. Journal of Practical Hepatology, 2020, 23(6): 873-876.
[13]	Xu Yonghua, Wang Hao, Qin Chenglin, et al. Applicationof segmental hepatectomy for the treatment of patients with hepatolithiasis and effect on serum leukotriene and hepatic carbon monoxide levels [J]. Journal of Practical Hepatology, 2020, 23(6): 913-916.
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