A Comparative Study Of Two Kinds Of Improved Percutaneous Transhepatic Cholangioscopy In Treatment Of Hepatobiliary Stones

Hepatolithiasis has been known for its wide range lesion ,complexity, high complications rate,and high recurrence rate. The residual or recurrent rate of postoperative intrahepatic stones is high, even up to 70%. With the development of minimally invasive techniques, percutaneous transhepatic cholangioscopy(PTCS) has made important achievements in the treatment of bile duct stones, recurrent bile duct stones in particular .However, traditional percutaneous transhepatic cholangioscopy has not widely used in clinic because of its shortcomings.The main drawback is the treatment for a long time, surgery more often,and complications such as biliary tract infection, bleeding, fistula injuries and drainage tubedropped out are high.It is difficult for patients to accept.Since 2001 Our hospital has been improved PTCS and achieved remarkable results. This paper comparatively studies two kinds of improved PTCS surgical technique carried out in our huspital in order to improve the surgery techniques of PTCSObjective To compare the effects,merit and demeritand clinical value of two kinds of PTCS methods in treating hepatolithiasis in our hospital.Methods Retrospective analyses clinical data of 69 cases used different improved method treating hepatolithiasis in our department from February 2001 to October 2010 ,including two-step method in 58 cases and one-step method in 11 cases, and compare the blood loss, stone free rate, complication rate, length of stay.Results (1)The operative blood loss in two-setp group was 38.9±19.3ml(ranging from 15 to 100ml);accumulative total complications were 12 cases and complication rate was 20.7%(12/58), including 5 cases of cholangitis,1 case of drainage tube dropped off, 3 cases of hemobilia, 2 cases of perforation of fistula and 1 case of peritonitis ,and all complications were cured with conservative treatment;the rate of stones removed completely was 84.5%(49/58), and the average hospital stay was 22.9±8.7d (ranging from 10 to 59d). (2)The operative blood loss in one-step group was 54.0±27.0ml(ranging from 20 to 100ml), and 1 case more, up to 200ml bleeding, because of the expansion of fistula, then placed corresponding tube in fistula to stop bleeding and 1 week later removed stones with Phase 2 expansion of fistula;accumulative total complications were 3 cases and complication rate was 27.3%(3/11), including 2 cases of cholangitis, 1 case of hemobilia, without perforation of fistula ,peritonitis, bile leakage and drainage tube dropped off ,and all complications were cured with conservative treatment;the rate of stones removed completely was 81.8%(9/11), and the average hospital stay was 18.9±6.4d(ranging from 12 to 32d).(3)By statistical analysis,no significant differences were detected between two groups in accumulative total complications, the average hospital stay, or the rate of stones removed completely. There was significant differences in operative blood loss between both groups through t-test.Conclusion PTCS is a effective method in treating hepatobiliary stones. Both two improved PTCS have the advantage of good efficacy, safety, short total treatmenttime and so on. Two-step method is relatively less bleeding and it is the preferred method.It is more hemorrhage in one-stepn method, but the operative blood loss is in the range of acceptable level. Using one-step method in PTCS is way can be choose.Using sheath tube and rigid choledochoscope is the characteristic of improved PTCS and the key factor to develop successfully.