关键词: 复杂肝胆管结石, 胆石症, 经皮经肝胆道镜, 手术并发症, 内镜手术

Abstract: Objective To explore the effectiveness and safety of one-stage percutaneous transhepatic choledocholithotomy in elderly patients with complex intrahepatic and extrahepatic stones. Methods Between January 2021 and June 2021, there were 65 elderly patients with complicated liver diseases, including 34 males and 31 females. The average age was (67.2±10.3) years. According to the different surgical methods, they were randomly divided into observation group (n=36), and the bile duct stones were removed by one-stage percutaneous transhepatic cholangioscopy. In the control group (n=29), routine operations were performed, that is, choledocholithotomy, T-tube drainage or cholangioenterostomy. The liver function and stone recurrence of patients in the two groups were detected 6 months after operation, and the related indexes during perioperative period were recorded. Results 6 months after operation, the ALT, AST, TBil and DBil in the observation group were (24.7±11.4) U/L, (22.8±9.7) U/L, (21.8±2.6) mmol/L and (19.5±11.9) mmol/L/L, respectively, significantly lower than the control group [(36.2±9.3) U/L, (31.5±10.3) U/L, (31.3±7.5) mmol/L, (28.6±11.9) mmol/l, respectively, P<0.05]. The operation time, intraoperative blood loss, postoperative fasting time, postoperative exhaust time and hospitalization time in the observation group were (95.5±10.4) min, (45.1±9.3) mL, (15.2±6.6) h, (12.4±1.2) h and (4.5±0.6) d, respectively, they were significantly lower than those in the control group [(157.3±16.4) min, (92.3±10.8) mL, (27.3±5.9) h, (26.3±7.9) h, (6.8±1.0) d, respectively, P<0.05]. The recurrence rate of stones in the observation group was significantly lower than that in the control group (5% vs 28%, P<0.05). According to the analysis of binary logistic regression model, the one-stage percutaneous choledocholithotomy (OR=0.21, P=0.036, 95%CI: 0.052-0.89) can reduce the recurrence of stones, while the preoperative bilirubin is increased (OR=1.12, P=0.002, 95% CI: 1.01-1.48). Conclusion In elderly patients with complex intra- and extrahepatic stones, the single-stage percutaneous transhepatic cholangioscopic lithotripsy is safe, can improve stone clearance rate, reduce complications, and decrease the long-term recurrence of stones.

Key words: Complex hepatobiliary stones, Cholelithiasis, Percutaneous transhepatic cholangioscopy, Surgical complications, Endoscopic surgery