Clinical efficacy of percutaneous trans-hepatic choledochoscopic lithotripsy under ERAS mode
10.3760/cma.j.cn113884-20250127-00033
- VernacularTitle:ERAS管理模式下行经皮经肝胆道镜取石术的疗效
- Author:
Feifei YIN
1
;
Guowei YANG
;
Liming SONG
;
Fei DUAN
;
Zhanqiang LIANG
;
Jian GUO
;
Lei SHI
;
Xuemin LI
;
Xibin DUAN
Author Information
1. 郑州大学附属郑州中心医院肝胆胰外科，郑州 450007
- Publication Type:Journal Article
- Keywords:
Gallstones;
Enhanced recovery after surgery;
Percutaneous transhepatic cholangioscopic lithotripsy;
Therapy
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(6):415-419
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of percutaneous trans-hepatic choledochoscopic lithotripsy (PTCSL) in the treatment of recurrent hepatobiliary calculi under enhanced recovery after surgery (ERAS) mode.Methods:Clinical data of 88 patients with recurrent hepatobiliary calculi, who were treated with PTCSL at Zhengzhou Central Hospital Affiliated to Zhengzhou University and the First Affiliated Hospital of Xi'an Jiaotong University between June 2022 and June 2024 were retrospectively analyzed, including 34 males and 54 females, aged (52.0±13.8) years. The scheme includes preoperative education, prophylactic antibiotic application, ensuring the quality of surgery, early postoperative feeding and activity, etc. The operation can be divided into two fashions: percutaneous transhepatic cholangial drainage and PTCSL, which can be completed in one stage (one-stage expansion method) or in two stages (staged expansion method). Clinical data such as gender, age, operative time, intraoperative blood loss, residual stone, and surgical complications were recorded.Results:All 88 patients underwent PTCSL under ERAS mode successfully, including 52 cases using one-stage expansion method and 36 cases using staged expansion method. The operative time was (53±20) min, the intraoperative blood loss was (9.7±3.8) ml, the postoperative hospital stay was (3.6±1.7) d, and the hospitalization cost was (17 500±4 700) yuan. Sixty-nine patients (78.4%, 69/88) had one-time stone removal in the first PTCSL. A total of 19 cases of residual stones were managed again by percutaneous sinus soft choledochoscopy, of which 12 cases were managed by one-time choledochoscopy, five cases by two-time choledochoscopy, and two cases by three-time choledochoscopy. The rate of residual stone was significantly higher in one-stage expansion method compared to staged expansion method [28.8% (15/52) vs. 11.1% (4/36), P=0.040]. No death, conversion to open surgery, or severe complications such as intra-abdominal hemorrhage or bile leakage occurred in the patients. No residual stones or recurrence were found during the follow-ups of (7.5±2.1) months after discharge. Conclusion:PTCSL under ERAS mode is safe and effective in the treatment of recurrent hepatobiliary calculi.
