Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis

ObjectiveTo investigate the clinical effect of two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of complex hepatolithiasis. MethodsA retrospective analysis was performed for the clinical data of 118 patients with complex hepatolithiasis who were admitted to 3201...

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Autor principal:	DUAN Changhu
Formato:	article
Lenguaje:	ZH
Publicado:	Editorial Department of Journal of Clinical Hepatology 2021
Materias:	Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/1ed9274f6b32443ea9baaae7b773d13a
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spelling	oai:doaj.org-article:1ed9274f6b32443ea9baaae7b773d13a2021-11-17T11:14:20ZEffectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis1001-5256https://doaj.org/article/1ed9274f6b32443ea9baaae7b773d13a2021-11-01T00:00:00Zhttp://www.lcgdbzz.org/cn/article/doi/10.3969/j.issn.1001-5256.2021.11.029https://doaj.org/toc/1001-5256ObjectiveTo investigate the clinical effect of two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of complex hepatolithiasis. MethodsA retrospective analysis was performed for the clinical data of 118 patients with complex hepatolithiasis who were admitted to 3201 Hospital of Xi’an Jiaotong University Health Science Center from January 2018 to June 2020, and according to the surgical procedure, they were divided into PTCSL group with 60 patients and surgery group with 58 patients. All patients were followed up for half a year to 3 years via telephone and outpatient service. The two groups were compared in terms of general information, perioperative indicators (including time of operation, intraoperative blood loss, incision length, time to first flatus and time to first defecation after surgery, time to extraction of abdominal drainage tube, and length of hospital stay), changes in liver function and inflammatory indicators, postoperative complications (bile leakage, acute cholangitis, wound infection, and venous thrombosis of lower extremities), stone clearance rate and recurrence rate, and quality of life. The two-independent-samples t-test was used for comparison of continuous data between two groups; the paired t-test was used for comparison between different periods of time within group; the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the surgery group, the PTCSL group had significantly shorter time of operation, time to first flatus and time to first defecation after surgery, and time to extraction of abdominal drainage tube, a significantly lower intraoperative blood loss, and a significantly shorter incision length (all P＜0.05). On day 1 after surgery, both groups had significant reductions in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P＜0.05) and a significant increase in white blood cell count (WBC) (P＜0.05), and the PTCSL group had significantly lower levels of ALT, AST, and WBC than the surgery group (all P＜0.05). Compared with the surgery group, the PTCSL group had significantly lower incidence rates of postoperative bile leakage (5.0% vs 17.2%, P＜0.05), acute cholangitis (3.3% vs 13.8%, P＜0.05), wound infection (1.7% vs 10.3%, P＜0.05), and venous thrombosis of lower extremities (1.7% vs 12.1%, P＜0.05). Compared with the surgery group, the PTCSL group had a significantly higher stone clearance rate (58.3% vs 37.9%, P＜0.05) and a significantly lower long-term stone recurrence rate (10.0% vs 207%, P＜0.05). The PTCSL group had significantly higher quality of life scores than the surgery group (all P＜0.05). ConclusionFor the treatment of complex hepatolithiasis, two-step PTCSL can effectively remove stones, with the advantages of fast postoperative recovery, low recurrence rate and incidence rate of complications, and high quality of life, and therefore, it is an effective alternative surgical procedure.DUAN ChanghuEditorial Department of Journal of Clinical HepatologyarticleDiseases of the digestive system. GastroenterologyRC799-869ZHLinchuang Gandanbing Zazhi, Vol 37, Iss 11, Pp 2636-2641 (2021)
institution	DOAJ
collection	DOAJ
language	ZH
topic	Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	Diseases of the digestive system. Gastroenterology RC799-869 DUAN Changhu Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
description	ObjectiveTo investigate the clinical effect of two-step percutaneous transhepatic choledochoscopic lithotomy (PTCSL) in the treatment of complex hepatolithiasis. MethodsA retrospective analysis was performed for the clinical data of 118 patients with complex hepatolithiasis who were admitted to 3201 Hospital of Xi’an Jiaotong University Health Science Center from January 2018 to June 2020, and according to the surgical procedure, they were divided into PTCSL group with 60 patients and surgery group with 58 patients. All patients were followed up for half a year to 3 years via telephone and outpatient service. The two groups were compared in terms of general information, perioperative indicators (including time of operation, intraoperative blood loss, incision length, time to first flatus and time to first defecation after surgery, time to extraction of abdominal drainage tube, and length of hospital stay), changes in liver function and inflammatory indicators, postoperative complications (bile leakage, acute cholangitis, wound infection, and venous thrombosis of lower extremities), stone clearance rate and recurrence rate, and quality of life. The two-independent-samples t-test was used for comparison of continuous data between two groups; the paired t-test was used for comparison between different periods of time within group; the chi-square test was used for comparison of categorical data between two groups. ResultsCompared with the surgery group, the PTCSL group had significantly shorter time of operation, time to first flatus and time to first defecation after surgery, and time to extraction of abdominal drainage tube, a significantly lower intraoperative blood loss, and a significantly shorter incision length (all P＜0.05). On day 1 after surgery, both groups had significant reductions in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) (P＜0.05) and a significant increase in white blood cell count (WBC) (P＜0.05), and the PTCSL group had significantly lower levels of ALT, AST, and WBC than the surgery group (all P＜0.05). Compared with the surgery group, the PTCSL group had significantly lower incidence rates of postoperative bile leakage (5.0% vs 17.2%, P＜0.05), acute cholangitis (3.3% vs 13.8%, P＜0.05), wound infection (1.7% vs 10.3%, P＜0.05), and venous thrombosis of lower extremities (1.7% vs 12.1%, P＜0.05). Compared with the surgery group, the PTCSL group had a significantly higher stone clearance rate (58.3% vs 37.9%, P＜0.05) and a significantly lower long-term stone recurrence rate (10.0% vs 207%, P＜0.05). The PTCSL group had significantly higher quality of life scores than the surgery group (all P＜0.05). ConclusionFor the treatment of complex hepatolithiasis, two-step PTCSL can effectively remove stones, with the advantages of fast postoperative recovery, low recurrence rate and incidence rate of complications, and high quality of life, and therefore, it is an effective alternative surgical procedure.
format	article
author	DUAN Changhu
author_facet	DUAN Changhu
author_sort	DUAN Changhu
title	Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
title_short	Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
title_full	Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
title_fullStr	Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
title_full_unstemmed	Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
title_sort	effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis
publisher	Editorial Department of Journal of Clinical Hepatology
publishDate	2021
url	https://doaj.org/article/1ed9274f6b32443ea9baaae7b773d13a
work_keys_str_mv	AT duanchanghu effectivenessandsafetyoftwosteppercutaneoustranshepaticcholedochoscopiclithotomyintreatmentofcomplexhepatolithiasis
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Effectiveness and safety of two-step percutaneous transhepatic choledochoscopic lithotomy in treatment of complex hepatolithiasis

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