A Two-Step Method for Percutaneous Transhepatic Choledochoscopic Lithotomy

This protocol significantly improves the success rate of percutaneous transhepatic choledochoscopy and achieves a better prognosis of intrahepatic and extrahepatic choledocholithiasis. This technique reduces the recurrence of intrahepatic and extrahepatic choledocholithiasis and shortens the whole lithotripsy period, operation time, and the distance between skin entrance sites and targeted biliary ducts. PTCSL can be a better choice for the treatment of complex intrahepatic and extrahepatic choledocholithiasis, such as in patients who had undergone previous complicated abdominal surgery or who had anatomical abnormalities and were unable to undergo an endoscopic examination.

This technique can also be used for percutaneous nephrolithotomy to manage kidney stone problems. The structure of the intrahepatic bile duct is complex and vulnerable to injury, which raises the surgical risk, and the visual demonstration can better avoid these dangerous complications. One week before the operation, perform the procedure for percutaneous transhepatic cholangio drainage, or PTCD.

Insert an indwelling 8F biliary drainage tube to drain and reduce the swelling of the bile duct. Wait for the sinus tract to become stable at one week after this procedure. Inject 20 milliliters of saline into the bile duct along the drainage tube.

After a guide wire is inserted into it, pull out the PTCD tube. To place the fascia dilator in sheath, expand the sinus using a 16F expander and join a 16F belt dilator so that the 16F sheath can reach the bile duct where the stone might have been placed. Locate the stones.

Use clamping forceps to break and remove the stones. Wash out small stones and powdered stones using an adjustable pressure pump. At the end of the procedure, leave a drainage tube inside the patient for one week.

Using PTCSL, all patients had their biliary tract stones cleared successfully. 72%of the patients had the bile duct stones completely removed after the first operation, while 28%of the patients required more than one operation. 56 patients underwent percutaneous liver surgery and 25 patients underwent surgery by indwelling a sinus formed by a T tube.

The number of stones was equal to one in 70 patients. The average hospital stay was 11 days. There was a complication of a small amount of reactive pleural effusion.

Minor intraoperative biliary bleeding was observed in two patients, and one patient had a biliary infection after surgery. However, no massive hemorrhaging of the biliary tract was observed. Preoperative ultrasound was used to accurately locate the stone location and to retain the 8F drain, and the sinus was directly expanded using a 16F expander.