ĐẶC ĐIỂM LÂM SÀNG VÀ CẬN LÂM SÀNG CỦA BỆNH NHÂN CÓ BIẾN CHỨNG CHẢY MÁU DO TÁN SỎI MẬT QUA DA BẰNG LASER TẠI BỆNH VIỆN ĐẠI HỌC Y HÀ NỘI

Abstract

Objectives: To describe the clinical and paraclinical characteristics of patients who experienced hemorrhagic complications after percutaneous transhepatic cholangioscopic lithotripsy with LASER at Hanoi Medical University Hospital. Materials and methods: A retrospective, cross-sectional descriptive study was conducted on 26 patients who developed hemorrhage requiring intervention after undergoing percutaneous transhepatic cholangioscopic lithotripsy with LASER at Hanoi Medical University Hospital from March 2020 to March 2025. Results: A total of 26 patients (mean age 63.7 ± 13.4 years, with females accounting for 61.5%) experienced biliary tract bleeding that required intervention. Pre-procedural cholangitis was noted in 76.9% of cases, and cirrhosis in 38.5%. Hemorrhage sources identified on digital subtraction angiography (DSA) included hepatic artery in 65.4% (17 patients), hepatic parenchyma in 15.4% (4 patients), hepatic and/or portal veins in 15.4% (4 patients), and both arterial and venous origins in 3.8% (1 patient). On computed tomography (CT), active bleeding from the artery was observed in 19.2% (5 patients). The mean decrease in hemoglobin was 18 g/L, and the INR increased from 1.05 to 1.26 post-procedure. Conclusion: Hemorrhage following percutaneous transhepatic cholangioscopic lithotripsy with LASER is a rare but serious complication that may result from injury to hepatic vessels or parenchyma. This complication is more likely to occur in patients with risk factors such as cholangitis, cirrhosis, or use of a large-caliber lithotripsy access port. DSA plays a pivotal role in identifying the bleeding source and managing the complication.