BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional mul...BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.展开更多
目的探讨三维可视化(3D)技术和超声(US)技术引导经皮肝Ⅰ期造瘘联合硬镜靶向碎石治疗复杂肝胆管结石的价值。方法选取65例复杂性肝胆管结石患者,随机分2组,观察组(3D+US组):3D和US技术引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者33例;对照组...目的探讨三维可视化(3D)技术和超声(US)技术引导经皮肝Ⅰ期造瘘联合硬镜靶向碎石治疗复杂肝胆管结石的价值。方法选取65例复杂性肝胆管结石患者,随机分2组,观察组(3D+US组):3D和US技术引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者33例;对照组(US组):US引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者32例。比较两组患者的手术时间、手术出血量、结石清除率、术后住院时间、术后并发症。结果观察组的手术时间(65.6±12.9 min vs 74.5±13.6 min,t=2.686,P=0.009)短于对照组,差异性比较具有统计学意义(P<0.05);两组的手术出血量(22.2±5.4 ml vs 25.7±10.2 ml,t=-1.748,P=0.085)、结石清除率(93.9%vs 90.6%,χ^2=0.251,P=0.616)、术后住院时间(6.8±2.1 d vs 7.2±2.4d,t=0.751,P=0.456)、并发症发生率(9.1%vs 12.5%,χ^2=0.196,P=0.658)等,差异性比较无统计学意义(P>0.05)。结论3D和超声引导经皮肝Ⅰ期造瘘联合硬镜靶向治疗复杂肝胆管结石是一种微创、安全、高效的方法,具有一定的应用前景。展开更多
目的分析预测硬质胆道镜经皮经肝胆道造瘘(PTBF)取石术治疗肝内胆管结石的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库1990年1月1日至2022年3月1日使用硬质胆道镜PTBF取石术治疗...目的分析预测硬质胆道镜经皮经肝胆道造瘘(PTBF)取石术治疗肝内胆管结石的临床疗效。方法计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据库1990年1月1日至2022年3月1日使用硬质胆道镜PTBF取石术治疗肝内胆管结石的研究。采用马尔科夫链蒙特卡洛方法模拟后验分布进行贝叶斯分析,分析结石取尽率、结石复发率、术后总并发症发生率、术后胆道相关并发症发生率等指标。结果最终纳入15篇文献1 296例患者,其中文献中明确显示为复杂性肝内胆管结石患者1 008例[分为经皮经肝I期胆道造瘘(PTOBF)取石组(n=568)与经皮经肝II期胆道造瘘(PTTBF)取石组(n=440)]。PTOBF取石术治疗肝内胆管结石的结石取尽率、复发率、术后总并发症率分别为84.19%(95%HPD:79.08%~88.93%)、15.79%(95%HPD:11.01%~21.07%)、10.85%(95%HPD:7.93%~14.21%)。对于复杂性肝内胆管结石:PTOBF取石术的结石取尽率、复发率、术后总并发症率分别为82.58%(95%HPD:75.46%~88.83%)、17.99%(95%HPD:11.51%~25.45%)、10.34%(95%HPD:6.42%~15.40%);PTTBF取石术的结石取尽率、复发率、术后总并发症率分别为73.56%(95%HPD:65.67%~80.30%)、29.48%(95%HPD:23.13%~36.01%)、11.42%(95%HPD:6.18%~17.67%)。与PTTBF取石组相比,PTOBF取石组取石效率更高(OR=1.74,95%CI:1.17~2.60)、结石复发率更低(OR=0.56,95%CI:0.37~0.84),但并没有增加总并发症发生率(OR=1.03,95%CI:0.66~1.62)与胆道感染发生率(OR=1.12,95%CI:0.61~2.04)。结论使用硬质胆道镜PTBF取石术治疗肝内胆管结石安全、有效。对于复杂性肝内胆管结石,PTOBF取石组的取石效率更高、结石复发率更低。展开更多
基金Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period,No.FSPY145205The Medical Research Project of Foshan Health Bureau,No.20230814A010024+1 种基金The Guangzhou Science and Technology Plan Project,No.202102010251the Guangdong Science and Technology Program,No.2017ZC0222.
文摘BACKGROUND Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide.Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy(PTCSL).AIM To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation(PTOBF)technique guided by three-dimensional(3D)visualization.METHODS This was a retrospective,single-center study analyzing,140 patients who,between October 2016 and October 2023,underwent one-step PTCSL for hepatolithiasis.The patients were divided into two groups:The 3D-PTOBF group and the PTOBF group.Stone clearance on choledochoscopy,complications,and long-term clearance and recurrence rates were assessed.RESULTS Age,total bilirubin,direct bilirubin,Child-Pugh class,and stone location were similar between the 2 groups,but there was a significant difference in bile duct strictures,with biliary strictures more common in the 3D-PTOBF group(P=0.001).The median follow-up time was 55.0(55.0,512.0)days.The immediate stone clearance ratio(88.6%vs 27.1%,P=0.000)and stricture resolution ratio(97.1%vs 78.6%,P=0.001)in the 3D-PTOBF group were significantly greater than those in the PTOBF group.Postoperative complication(8.6%vs 41.4%,P=0.000)and stone recurrence rates(7.1%vs 38.6%,P=0.000)were significantly lower in the 3D-PTOBF group.CONCLUSION Three-dimensional visualization helps make one-step PTCSL a safe,effective,and promising treatment for patients with complicated primary hepatolithiasis.The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis.This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
文摘目的探讨三维可视化(3D)技术和超声(US)技术引导经皮肝Ⅰ期造瘘联合硬镜靶向碎石治疗复杂肝胆管结石的价值。方法选取65例复杂性肝胆管结石患者,随机分2组,观察组(3D+US组):3D和US技术引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者33例;对照组(US组):US引导经皮肝Ⅰ期造瘘联合硬镜治疗的患者32例。比较两组患者的手术时间、手术出血量、结石清除率、术后住院时间、术后并发症。结果观察组的手术时间(65.6±12.9 min vs 74.5±13.6 min,t=2.686,P=0.009)短于对照组,差异性比较具有统计学意义(P<0.05);两组的手术出血量(22.2±5.4 ml vs 25.7±10.2 ml,t=-1.748,P=0.085)、结石清除率(93.9%vs 90.6%,χ^2=0.251,P=0.616)、术后住院时间(6.8±2.1 d vs 7.2±2.4d,t=0.751,P=0.456)、并发症发生率(9.1%vs 12.5%,χ^2=0.196,P=0.658)等,差异性比较无统计学意义(P>0.05)。结论3D和超声引导经皮肝Ⅰ期造瘘联合硬镜靶向治疗复杂肝胆管结石是一种微创、安全、高效的方法,具有一定的应用前景。
