Abstract: Objective The aim of this study was to evaluate the efficacy and safety of percutaneous transhepatic biliary drainage (PTBD) and secondary percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of patients with acute cholangitis with choledocholithiasis. Methods 75 patients with acute cholangitis and choledocholithiasis were admitted to Changzhou Seventh People's Hospital between May 2017 and May 2020, and were divided into observation (n=39) and control group (n=36). All patients underwent emergency PTBD, and the patients in the observation group received second phase PTCSL and those in the control received laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE). All patients were followed-up for 12 months. Results The postoperative anal exhaust time and drainage tube indwelling time in the observation group were(19.6±3.3)h and (7.8±1.2) h, not significantly different compared to (20.4±3.5) h and (8.1±1.3) h in the control (P>0.05), while the operation time and hospital stay were (86.9±14.1)min and (9.5±1.5)d, both significantly shorter than [(124.6±19.8)min and (11.4±1.9)d, respectively, P<0.05] in the control group; 24 hours after operation, the visual analogue scale score in the observation group was (2.1±0.3), significantly lower than [(3.6±0.6), P<0.05] in the control; after operation, the incidence of complications, such as incision infection, bile leakage, pancreatitis and biliary bleeding in the observation group was 15.4%, not significantly different compared to 13.9% in the control (P>0.05); at the end of one-year follow-up, the incidences of residual stones and stone recurrence rates in the observation were 7.7% and 15.4%, not significantly different compared to 8.3% and 11.1% in the control (P>0.05). Conclusion PTBD combined with the second-stage PTCSL for the treatment of patients with acute cholangitis and common bile duct stones can shorten the operation time and hospital stay, reduce the amount of bleeding, and can reduce the postoperative pain response of the patient, which is safe and reliable.

Key words: Acute cholangitis, Choledocholithiasis, Percutaneous transhepatic biliary drainage, Percutaneous transhepatic choledochoscopic lithotomy, Therapy