A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy.

Intrahepatic and extrahepatic choledocholithiasis is a challenge in the field of biliary surgery. We present our experience using a two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) procedure to treat challenging biliary stones. We retrospectively reviewed 81 patients with intrahepatic and extrahepatic choledocholithiasis treated using this two-step PTCSL from January 2013 to January 2020, including 40 males and 41 females, with an average age of 66 years. In contrast to traditional percutaneous transhepatic cholangioscopy (PTCS), a channel was established directly through a 16F Amplatz sheath, and the stone in the channel was removed with the aid of a nephroscope. The clinical efficacy and complications of all patients were analyzed. Eighty-one patients (81/81, 100%) had their biliary stones successfully removed; 62/81 patients (76.5%) had biliary stones completely removed after the first operation; 17/81 patients (21%) underwent a second operation; 2/81 patients (2.5%) needed a third operation to completely remove the stones. The incidence of severe bleeding during the operation was 0%, and there were no deaths. The use of the two-step PTCSL method is safe and efficacious, and contributes to a better prognosis of intrahepatic and extrahepatic choledocholithiasis.

Percutaneous Transhepatic Choledochoscopic Lithotomy (PTCSL) is Effective for the Treatment of Intrahepatic and Extrahepatic Choledocholithiasis.

BACKGROUND: To explore percutaneous transhepatic choledochoscopic lithotomy (PTCSL) as a treatment for intrahepatic and extrahepatic choledocholithiasis. PATIENT AND METHODS: A retrospective review of 67 patients with intrahepatic and extrahepatic choledocholithiasis treated by PTCSL from January 2014 to January 2019, including 36 males and 31 females, with an average age of 66 years. During the operation, the doctor established a channel through a 16-Fr Amplatz sheath and removed the stone in the channel with the aid of nephroscope. The clinical efficacy and complications of all patients were analyzed. RESULTS: Sixty-seven patients (67/67, 100%) had their stones successfully removed in the first operation. Only 2 patients (2/67, 3.0%) developed mild reactive pleural effusion after the operation, and 1 patient (1/67, 1.5%) with cholangiocarcinoma after the operation. The incidence of severe bleeding during the operation was 0%. CONCLUSION: PTCSL is a minimally invasive, simple, effective and easy to repeat procedure for use in the clinic. It is an effective surgical treatment and is worthy of clinical use.