The Curative Effect Of Percutaneous Transhepatic Cholangioscopy(PTCS) In The Treatment Of Intrahepatic And Extrahepatic Bile Duct Stones

Objective:To explore the effect of percutaneous transhepatic cholangioscopy(PTCS)and laparoscopy on the treatment for intrahepatic and extrahepatic bile duct stones,PTCS was compared with laparoscopic surgery and laparotomy.Methods:The clinical data of 100 patients with intrahepatic and extrahepatic bile duct stones who received treatment in the third ward of hepatobiliary pancreatic surgery,the second affiliated hospital of Kunming medical university from December 2015 to November 2017 were retrospectively analyzed.According to the operation method,100 patients were divided into the PTCS group(n=33),laparoscopy group(n=31)and laparotomy group(n=36).PTCS group:Intrahepatic and extrahepatic bile duct stones were treated with percutaneous transhepatic cholangioscopy(PTCS),hard choledochoscope or fiberoptic choledochoscope and holmium laser or pneumatic ballistics;Laparoscopy group:Intrahepatic and extrahepatic bile duct stones were treated under laparoscopy.There were cholenterostomy,biliary exploration and T tube drainage.Intrahepatic and internal bile duct stones were treated with fiberoptic choledochoscope;Laparotomy group:Intrahepatic and intrahepatic bile duct stones were treated with open surgery.There were cholenterostomy,biliary exploration and T tube drainage.Intrahepatic and internal bile duct stones were treated with fiberoptic choledochoscope.We observed the general clinical data,SPSS 21.0 software was used for analysis,gender,age,clinical symptoms,situation of stones,situation of jaundice,live function,surgical history,and complications had no significant differences in the three groups(P>0.05).The operative and postoperative condition were counted,operation situation(operation time,blood loss),complications(biliary tract bleeding,bile duct infection,biliary fistula),live function 3 days after surgery(bilirubin,alanine aminotransferase,aspartate aminotransferase),postoperative ventilation time,the rate of postoperative residual stones,costs,hospitalization days,patients satisfaction etc.SPSS 21.0 software was used for analysis,P<0.05,the difference was statistically significant,P>0.05,the difference was not statistically significant.Results:100 patients of successful operation,there was no death case.Operation time,blood loss,postoperative ventilation time,bilirubin,alanine aminotransferase,aspartate aminotransferase,hospitalization days,costs and patients satisfaction had significant differences in the three groups(P<0.05),The PTCS group was significantly lower than the other two groups.There were 2 patients with stone residues in the PTCS group,the rate of postoperative residual stones was 6%.There were 8 patients with stone residues in the laparoscopic group,the rate of postoperative residual stones was 26%.There were 9 patients with stone residues in the laparotomy group,the rate of postoperative residual stones was 25%.The rate of postoperative residual stones of the PTCS groups was significantly lower than the other two groups(P<0.05).There were 1 patient with biliary tract bleeding and 3 patients with bile duct infection in the PTCS group,There weren't significant differences in the three groups(P>0.05).Conclusions:Operation time,blood loss,costs,hospitalization days and the rate of postoperative residual stones all less the PTCS group than the laparoscopy group and laparotomy group,higher satisfaction,recover rapidly.Percutaneous transhepatic cholangioscopy(PTCS)on the treatment for intrahepatic and extrahepatic bile duct stones,is valuable to be popularized.