经皮经肝十二指肠乳头肌扩张顺行排石术联合双频双脉冲激光碎石治疗大直径胆总管结石

Percutaneous transhepatic papillary balloon dilation combined with dual-frequency double-pulse laser lithotripsy for large-diameter common bile duct stones

目的本研究旨在评估经皮经肝十二指肠乳头肌扩张顺行排石术联合输尿管软镜引导双频双脉冲ND:YAG激光碎石术(PTPBD-FREDDY)治疗巨大(直径>1.5 cm)胆总管结石的安全性和有效性。方法回顾性分析2017年12月至2021年10月在山东大学第二医院和山东颐养健康集团新汶中心医院收治的26例大直径困难胆总管结石患者,其中4例患者无法耐受外科手术或内镜治疗,6例患者内镜治疗失败,另外16例患者拒绝接受内镜或手术治疗。所有患者均接受了PTPBD-FREDDY治疗,首先在输尿管镜监视下应用FREEDY激光将结石粉碎,然后应用球囊将结石推送入十二指肠内。主要研究终点为技术成功率,次要研究终点包括结石复发率以及相关并发症。结果26例患者均成功完成手术,技术成功率为100%。胆色素结石的平均碎石频率和手术时间显著高于混合结石和胆固醇结石(P<0.01)。术后主要并发症包括轻度发热3例、腹痛3例、恶心2例和呕吐1例,1例患者出现胆管出血,经保守治疗后好转,未观察到胰腺炎、败血症或胆管穿孔等严重并发症。术后随访2年,未观察到结石复发的病例。结论PTPBD-FREDDY技术对于巨大胆总管结石患者来说是一种安全、有效的治疗方法。它为无法耐受手术、内镜治疗失败的巨大胆总管结石患者提供了一种新的治疗手段,具有良好的前景。

Objective To evaluate the safety and efficacy of percutaneous transhepatic papillary balloon dilation(PTPBD)combined with flexible ureteroscopy-guided dual-frequency double-pulse ND:YAG(FREDDY)laser lithotripsy(PTPBD-FREDDY)for the treatment of giant(>1.5 cm diameter)common bile duct stones.Methods A retrospective analysis was conducted on 26 patients with large-diameter difficult choledocholithiasis admitted to two medical centers from December 2017 to October 2021.Among these patients,four could not tolerate surgery or endoscopic treatment,six experienced failure of endoscopic treatment,and 16 refused to undergo endoscopic or surgical treatment.All patients underwent the PTPBD-FREDDY procedure.The FREDDY laser lithotripsy was performed under ureteroscopic guidance,followed by a balloon to push the stones into the duodenum.The primary endpoint was the technical success rate,and the secondary endpoints included the rate of stone recurrence and related complications.Results All 26 patients successfully completed the operation,achieving a technical success rate of 100%.The average lithotripsy frequency and operation time for bilirubin stones were significantly higher than those of mixed stones and cholesterol stones(P<0.01).The main postoperative complications included mild fever(n=3),abdominal pain(n=3),nausea(n=2)and vomiting(n=1).One patient experienced biliary tract bleeding,which improved after conservative treatment.No serious complications such as pancreatitis,sepsis,or biliary perforation were observed.After 2 years of follow-up,no cases of stone recurrence were observed.Conclusions PTPBD-FREDDY is a safe and effective treatment for patients with giant common bile duct stones.It provides a new therapeutic option for patients with giant choledocholithiasis who can not tolerate surgery or have failed endoscopic treatment,demonstrating promising prospects.