ĐÁNH GIÁ KẾT QUẢ NỘI SOI TÁN SỎI ĐƯỜNG MẬT XUYÊN GAN QUA DA BẰNG LASER DƯỚI HƯỚNG DẪN X-QUANG SỐ HOÁ XOÁ NỀN TẠI BỆNH VIỆN HỮU NGHỊ VIỆT ĐỨC

Abstract

Objectives: Assessing outcomes of percutaneous transhepatic cholangioscopic with laser lithotripsy biliary under digital subtraction angiography guidance at Viet Duc University Hospital from march 2022 to august 2022. Subjects and methods: A prospective study of cases undergoing percutaneous transhepatic endoscopic lithotripsy under the guidance of ultrasound and digital subtration angiography at Viet Duc University Hospital from march 2022 to august 2022. Results: 50 patients met the inclusion criteria for the study, including 33 females (66%) and 17 males (34%), average age was 57.5 ± 16.8 years old (min 20 years old–max 93 years old). 41 patients (82%) had a history of biliary stones removal surgery, 25 patients had biliary stricture. Choledocholithiasis was observed in 16 patients (32%), 20 patients (40%) had intrahepatic and extrahepatic bile duct stones, the remaining patients had stones in the right and left intrahepatic bile ducts. The average size of gallstones in the liver was 21.4 ± 12.4mm (min 5mm – max 65mm) and common bile duct stone was 22.7 ± 15.1mm (min 4mm - max 82mm). The percutaneous transhepatic rigid cholangioscopic lithotripsy procedure with the appropriate ratio of portals for each patient of 14Fr (12.3%), 16Fr (14.0%), 18Fr (73.7%) increased the stone clearance rate after the procedure with the average stone clearance rate for intra- and extrahepatic stones (97.8 ± 6.1%), the rate of stone clearance in the common bile duct was 100% and the rate of intrahepatic stone clearance was 96.7 ± 7.1% , low lithotripsy time (46.6 ± 28.8 minutes), short hospitalization (5.9 ± 3.7 days) and low complication rate (7/50 patients accounted for 14%). Moderate - mild complications related to the procedure: 5 patients had a small right pleural effusion; 1 patient with transient fever after the procedure was treated with antibiotics and stabilized after 3 days; 1 patient with hemobilia was stable medically. Conclusion: The Percutaneous transhepatic cholangioscopic lithotripsy technique by laser under the guidance digital subtration angiography and ultrasound is a safe and effective technique in the treatment of biliary stone.