Ultrasound-guided double-tract percutaneous cholecystostomy combined with a choledochoscope for performing cholecystolithotomies in high-risk surgical patients

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• 作者：Tao Wang (1)
  Tao Chen (1)
  Shu Zou (1)
  Ning Lin (1)
  Hong-yin Liang (1)
  Hong-tao Yan (1)
  Nan-lin Li (2)
  Li-ye Liu (1)
  Hao Luo (1)
  Qi Chen (1)
  Wei-hui Liu (1)
  Li-jun Tang (1)
  
• 关键词：Cholecystolithotomy ; Minimally invasive therapy ; Percutaneous cholecystostomy ; Choledochoscope
• 刊名：Surgical Endoscopy
• 出版年：2014
• 出版时间：July 2014
• 年：2014
• 卷：28
• 期：7
• 页码：2236-2242
• 全文大小：1,880 KB
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• 作者单位：Tao Wang (1)
  Tao Chen (1)
  Shu Zou (1)
  Ning Lin (1)
  Hong-yin Liang (1)
  Hong-tao Yan (1)
  Nan-lin Li (2)
  Li-ye Liu (1)
  Hao Luo (1)
  Qi Chen (1)
  Wei-hui Liu (1)
  Li-jun Tang (1)
  
  1. General Surgery Center, Chengdu Military General Hospital, Chengdu, 610083, Sichuan, China
  2. Department of Vascular and Endocrine Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, 710032, Shaanxi, China
  
• ISSN：1432-2218

文摘

Background Cholecystolithiasis is the most common disease treated by general surgery, with an incidence of about 0.15-.22?%. The most common therapies are open cholecystectomy (OC) or laparoscopic cholecystectomy (LC). However, with a greater understanding of the function of the cholecyst, more and more patients and surgeons are aware that preserving the functional cholecyst is important for young patients, as well as patients who would not tolerate anesthesia associated with either OC or LC. Based on these considerations, we have introduced a notable, minimally invasive treatment for cholecystolithotomy. Methods We performed a retrospective review of patients with cholecystolithiasis who were unable to tolerate surgery or who insisted on preserving the functional cholecyst. Our particular approach can be simply described as ultrasound-guided percutaneous cholecystostomy combined with a choledochoscope for performing a cholecystolithotomy under local anesthesia. Results Ten patients with cholecystolithiasis were treated via this approach. All except one patient had their gallbladder stones totally removed under local anesthesia, without the aggressive procedures associated with OC or LC. The maximum number of gallbladder stones removed was 16, and the maximum diameter was 13?mm?without lithotripsy. After the minimally invasive surgery, the cholecyst contractile functions of all patients were normal, confirmed via ultrasound after a high-fat diet. Complications such as bile duct injury, biliary fistula, and bleeding occurred significantly less often than with OC and LC. The recurrence rates for each of 2 post-operative years were about 11.11?% (1/9, excluding a failure case) with uncertainty surrounding recurrence or residue, and 22.22?% (2/9, including one non-recurrence patient with follow-up time of 22?months), respectively. Conclusions Ultrasound-guided percutaneous cholecystostomy combined with choledochoscope is a safe, efficient, and minimally invasive cholecystolithotomy method. We recommend this technique for the management of small stones (less than 15?mm) in high-risk surgical patients.