KẾT QUẢ BƯỚC ĐẦU CAN THIỆP QUA DA XUYÊN GAN ĐIỀU TRỊ HẸP ĐƯỜNG MẬT LÀNH TÍNH BẰNG LASER BỐC HƠI THULIUM TẠI BỆNH VIỆN ĐẠI HỌC Y HÀ NỘI

Abstract

Background: Benign biliary stricture (BBS) is defined as a segmental narrowing of the intrahepatic or extrahepatic bile duct system, which reduce bile flow and leads to upstream dilatation, result in complications such as cholangitis, bile duct stones, and hepatic parenchymal atrophy. The treatment of BBS, particularly in cases of severe narrowing, remains challenging. The use of thulium laser has been widely applied in the management of ureteral strictures and urethral strictures secondary to benign prostatic hyperplasia. Therefore, this study was conducted to evaluate the outcomes of percutaneous intervention using thulium laser in the treatment of benign biliary strictures. Methods: Retrospective study in 26 patients diagnosed and treated at Hanoi Medical University Hospital using percutaneous thulium laser ablation. Results: The mean age was 48.92 ± 12.89 years, female-to-male ratio of 2.25:1. Right upper quadrant abdominal pain, fever, and jaundice were observed in 100%, 38.5%, and 11.5% of patients, respectively. All patients had biliary stones. The most common sites of stricture were the right and left hepatic ducts, accounting for 34.6%  and 42.3% of cases, respectively. Strictures in the posterior segmental, anterior segmental, and subsegmental branch III ducts each accounted for <10%. The hepatic artery and portal vein were most frequently located posterior, inferior, and postero-inferior to the stricture in 57.69%, 15.38%, and 19.23% of cases, respectively. Anterior and superior positions were rare (3.85%). The technical success rate was 100%. Minor complications occurred in 2 of 26 patients (7.7%), included mild hemobilia without the need for surgical or interventional treatment. No major complications or deaths were recorded. The mean diameter of the stricture increased significantly from 1.6 ± 1.3 mm before to 7.5 ± 2.4 mm after ablation (p < 0.001). During a mean follow-up period of 11,7 months, 77% of patients remained asymptomatic. Severe restenosis occurred in 2 patients (7.7%) requiring surgery or repeat intervention. Recurrent bile duct stones were observed in 4 patients (15.4%). Conclusion: Percutaneous treatment of benign biliary strictures using thulium laser vaporization demonstrates promising initial outcomes, with a high technical success rate, low complication rate, and significant clinical and imaging improvement.