Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.

Objective:To analyze the safety and efficacy of percutaneous transhepatic endoscopic holmium laser lithotripsy combined with papillary muscle balloon dilation (PTBL-PBD) in the treatment of refractory common bile duct (CBD) stones.Methods:Clinical data of eight patients with CBD stones who underwent PBD treatment in the Department of Interventional and Vascular Surgery of Wanning People's Hospital from March 2023 to October 2024 were retrospectively collected, including seven males and one female, aged 71.6±6.9 years. Under local anesthesia, a passage was established through percutaneous transhepatic biliary puncture, combined with holmium laser lithotripsy and balloon lithotripsy. Two weeks after the operation, angiography was performed to evaluate the therapeutic effect. Bile culture of bacteria were collected from the patients. Symptoms including fever, jaundice, abdominal pain and complications of the patients after the operation were recorded. The white blood cell (WBC) count, hypersensitive C-reactive protein (CRP), total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT) one week before and one week after the operation were analyzed. All patients were followed up.Results:Eight patients successfully completed the surgery. No residual stone in the biliary system were observed in the imaging two weeks after the operation in six of the patients, and the biliary drainage tubes were successfully removed. Residual stone were observed in two of the patients, which were completely removed through re-treatment with balloon lithotripsy. Biliary bacterial infection occurred in four cases after the operation, including three cases with Escherichia coli and one with Klebsiella pneumoniae. One case with postoperative biliary hemorrhage was managed with coil embolization for hemostasis. The symptoms such as fever, jaundice and abdominal pain of the patients were all relieved after the operation. The WBC count decreased from 14.3±2.8 ×10 9/L before the operation to 6.1±1.3 ×10 9/L, and the high-sensitivity CRP decreased from 58.7±15.2 mg/L to 8.4±3.6 mg/L. Total bilirubin decreased from 102.2±27.7 μmol/L to 17.6±5.5 μmol/L, AST decreased from 137.6±36.7 U/L to 30.4±9.9 U/L, and ALT decreased from 141.3±44.9 U/L to 32.4±10.8 U/L. Two patients were followed up for 24 months, five for 12 months, and one for 6 months. No long-term complications such as stone recurrence or bile duct stenosis were observed during the follow-ups, and there were no clinical symptoms such as fever, jaundice, or abdominal pain. Conclusion:The treatment of refractory common bile duct stones with PTBL-PBD has less trauma and high safety, and could be suitable for high-risk patients who have failed with endoscopic approaches or cannot tolerate general anesthesia.