| Objective:To compare the therapeutic effects of two different modes of percutaneous transhepatic rigid choledochoscopy lithotripsy and laparoscopic surgery in the treatment of hepatolithiasis,and to compare the lithotomy efficiency of rigid choledochoscopy through percutaneous hepatic puncture and T-tube sinus.Overall analysis of the efficacy of percutaneous transhepatic rigid choledochoscopiclithotripsy in thetreatment of hepatolithiasis.Methods:A retrospective analysis was made of 178 patients with hepatolithiasis admitted to our hospital from January 2020 to December 2022,all of whom were successfully treated by surgery,including 42 cases of percutaneous transhepatic rigid choledochoscopy lithotripsy,70 cases of laparoscopic surgery,and 66 cases of rigid choledochoscopy lithotripsy via T-tube sinus.Comparative analysis was made of the surgical indicators,clinical efficacy,complications,economic indicators,and stone removal efficiency in the treatment of hepatolithiasis among the groups,To comprehensively understand the overall effect of percutaneous transhepatic rigid choledochoscopy in thetreatment of hepatolithiasis.Results:A retrospective analysis of 42 patients with percutaneous transhepatic choledochoscopy lithotripsy and 70 patients with laparoscopic lithotripsy showed that there was no significant statistical difference between the two groups in the baseline data of age,sex,liver function,stone classification,and the presence or absence of biliary cirrhosis,and the data of the two groups were comparable.The proportion of patients with previous biliary surgery history(31/42,73.80%)in the percutaneous transhepatic choledochoscopy lithotripsy group was significantly higher than that in the laparoscopic surgery group(12/70,17.14%),P<0.05.In terms of operation index and clinical effect,the total operation time(min)of percutaneous transhepatic choledochoscopy lithotripsy group(156.07 ± 74.74)was shorter than that of laparoscopic surgery group(191.91 ± 47.69),P<0.05.The median intraoperative total bleeding volume(ml)was 50.00(40.00,60.00),which was less than 180.00(120.00,212.50)in the laparoscopic surgery group,P<0.05.The final stone removal rate(32/42,76.19%)was slightly lower than that of laparoscopic surgery group(58/70,82.86%),but the difference was not statistically significant(P>0.05).The incidence of postoperative complications(6/42,14.28%)was slightly higher than that of laparoscopic surgery group(9/70,12.86%),but the difference was not statistically significant(P>0.05).In terms of economic indicators,the median of average total length of hospitalization and total cost of percutaneous transhepatic rigid choledochoscopy lithotripsy were lower than those of laparoscopic surgery,with a statistically significant difference(P<0.05).A retrospective analysis of 42 patients with percutaneous transhepatic rigid choledochoscopy lithotripsy and 66 patients with percutaneous trans-tube sinus rigid choledochoscopy lithotripsy showed that there was no significant statistical difference between the two groups in baseline data such as age,sex,stone distribution,stone size.In terms of stone removal efficiency,the median of total lithotripsy times 2.00,(1.00,3.00)and total stone removal time(min)142.50,(107.50,185.50)in the percutaneous transhepatic group were higher than those in the T-tube sinus group(P<0.05).The median intraoperative bleeding volume(ml)of 50.00(40.00,60.00)was slightly higher than that of 45.00(30.00,60.00)in the T-tube sinus group,and the difference was not statistically significant(P>0.05).In terms of stone removal rate,the one-time stone removal rate of percutaneous transhepatic lithotomy group(8/42,19.04%)was significantly lower than that of the T-tube sinus group(39/66,59.09%),and the difference was statistically significant,while the final stone removal rate of thetwo groupshad no significant difference(P>0.05)Conclusion:Percutaneous transhepatic rigid choledochoscopy lithotripsy for hepatolithiasis has the advantages of short operation time,less bleeding,fast recovery,short hospitalization time and low cost.The stone removal rate is equivalent to that of laparoscopic surgery,especially for complex intrahepatic bile duct stones with multiple previous biliary surgery history.Rigid choledochoscope has a higher efficiency in removing stones through the T-tube sinus.For patients with complex intrahepatic bile duct stones that still have many stones left after multiple stone removal,theestablishment of T-tube sinus stoneextraction can be considered. |
