Comparison between left and right approaches for PTOBF lithotripsy applied in type Ⅱa hepatolithiasis
10.3760/cma.j.cn113884-20240220-00049
- VernacularTitle:左肝管与右肝管入路PTOBF取石手术治疗Ⅱa型肝胆管结石的比较研究
- Author:
Xinqia ZHANG
1
;
Jinglin GONG
;
Ping WANG
;
Yongqing YE
;
Jinming FAN
Author Information
1. 广州医科大学附属第一医院肝胆外科，广州 510120
- Keywords:
Gallstones;
Percutaneous transhepatic one-step biliary fistulation;
Surgical approach
- From:
Chinese Journal of Hepatobiliary Surgery
2024;30(5):360-364
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the outcomes of percutaneous transhepatic one-step biliary fistulation (PTOBF) lithotripsy for type Ⅱa hepatolithiasis performed via the left or right lobe.Methods:A retrospective study was conducted on 79 patients with type Ⅱa hepatolithiasis treated in the First Affiliated Hospital of Guangzhou Medical University from January 2018 to December 2020, including 38 males and 41 females, aged (52.9±14.0) years. All patients had received PTOBF lithotripsy in single channel and divided into left lobe group ( n=40) and right lobe group ( n=39) according to different puncture approaches. Clinical data in immediate and final stone clearance rate, operation time of lithotripsy, intraoperative blood loss, postoperative complications (ascites, biliary tract infection), postoperative hospitalization time, reactive pleural effusion rate, the number of lithotripsy procedures and target bile duct dilatation diameter were compared between the two groups. Results:Compared with left lobe group, right lobe group had higher immediate stone clearance [51.3%(20/39) vs 22.5%(9/40)], less lithotripsy procedures [(2.4±1.0) vs (1.9±1.0)], but had longer postoperative hospitalization time [5(3, 6)d vs 3(2, 6)d] and higher reactive pleural effusion rate [23.1%(9/39) vs 2.5%(1/40)], the differences were all statistically significant (all P<0.05). No significant difference was found in target bile duct dilatation diameter, final stone clearance rate, intraoperative blood loss, postoperative complication rate, and operation time of lithotripsy (all P>0.05). Conclusions:Compared to the left lobe approach, right lobe approach could be prioritized in PTOBF lithotripsy for type Ⅱa hepatolithiasis, considering its higher immediate stone clearance and less lithotripsy procedures, but this surgical approach should pay attention to the occurrence of reactive pleural effusion.
