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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Three-dimensional visualization technology for guiding one-step percutaneous transhepatic cholangioscopic lithotripsy for the treatment of complex hepatolithiasis
Yong-Qing Ye, Ya-Wen Cao, Rong-Qi Li, En-Ze Li, Lei Yan, Zhao-Wei Ding, Jin-Ming Fan, Ping Wang, Yi-Xiang Wu
Yong-Qing Ye, Department of Hepatobiliary Surgery, The Second People’s Hospital of Foshan, Foshan 528000, Guangdong Province, China
Ya-Wen Cao, Department of Emergency Medicine, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Rong-Qi Li, Department of Hepatobiliary Surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan 528000, Guangdong Province, China
En-Ze Li, Lei Yan, Zhao-Wei Ding, Jin-Ming Fan, Ping Wang, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510282, Guangdong Province, China
Yi-Xiang Wu, Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, Guangdong Province, China
Co-first authors: Yong-Qing Ye and Ya-Wen Cao.
Author contributions: Wang P, Li RQ and Ye YQ conceptualized and designed the research; Li EZ, Ding ZW, Fan JM screened patients and acquired clinical data; Cao YW, Wu YX collected blood specimen and performed data analysis; Ye YQ and Cao YW wrote the paper; All the authors have read and approved the final manuscript. Cao YW proposed, designed and conducted data analysis and prepared the first draft of the manuscript. Ye YQ was responsible for patient screening, enrollment, collection of clinical data and blood specimens. Both authors have made crucial and indispensable contributions towards the completion of the project and thus qualified as the co-first authors of the paper.
Supported by The Key Medical Specialty Nurturing Program of Foshan During The 14th Five-Year Plan Period, No. FSPY145205; The Medical Research Project of Foshan Health Bureau, No. 20230814A010024; The Guangzhou Science and Technology Plan Project, No. 202102010251; and the Guangdong Science and Technology Program, No. 2017ZC0222.
Institutional review board statement: This study was approved by the Ethics Committee of The First Hospital of Guangzhou Medical University, No. 09, 2017.
Informed consent statement: Informed consent was obtained from the patients included in this research.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/licenses/by-nc/4.0/ Corresponding author: Ping Wang, PhD, Chief Doctor, Deputy Director, Full Professor, Surgeon, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang West Road, Yuexiu District, Guangzhou 510282, Guangdong Province, China. wangping1219@126.com
Received: January 24, 2024
Revised: May 18, 2024
Accepted: June 21, 2024
Published online: July 28, 2024
Processing time: 182 Days and 4 Hours
BACKGROUND
Biliary stone disease is a highly prevalent condition and a leading cause of hospitalization worldwide. Hepatolithiasis with associated strictures has high residual and recurrence rates after traditional multisession percutaneous transhepatic cholangioscopic lithotripsy (PTCSL).
AIM
To study one-step PTCSL using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization.
METHODS
This was a retrospective, single-center study analyzing, 140 patients who, between October 2016 and October 2023, underwent one-step PTCSL for hepatolithiasis. The patients were divided into two groups: The 3D-PTOBF group and the PTOBF group. Stone clearance on choledochoscopy, complications, and long-term clearance and recurrence rates were assessed.
RESULTS
Age, total bilirubin, direct bilirubin, Child-Pugh class, and stone location were similar between the 2 groups, but there was a significant difference in bile duct strictures, with biliary strictures more common in the 3D-PTOBF group (P = 0.001). The median follow-up time was 55.0 (55.0, 512.0) days. The immediate stone clearance ratio (88.6% vs 27.1%, P = 0.000) and stricture resolution ratio (97.1% vs 78.6%, P = 0.001) in the 3D-PTOBF group were significantly greater than those in the PTOBF group. Postoperative complication (8.6% vs 41.4%, P = 0.000) and stone recurrence rates (7.1% vs 38.6%, P = 0.000) were significantly lower in the 3D-PTOBF group.
CONCLUSION
Three-dimensional visualization helps make one-step PTCSL a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis. The perioperative and long-term outcomes are satisfactory for patients with complicated primary hepatolithiasis. This minimally invasive method has the potential to be used as a substitute for hepatobiliary surgery.
Core Tip: Hepatolithiasis is a clinical benign biliary tract disease with a high incidence and a leading cause of hospitalization, seriously affecting the quality of life of patients. However, current treatment modalities have not achieved good curative effects, with high rates of stone and stenosis retention and recurrence. In the present study we introduce a new technology that one-step percutaneous transhepatic cholangioscopic lithotripsy using the percutaneous transhepatic one-step biliary fistulation (PTOBF) technique guided by three-dimensional (3D) visualization technology. And we performed a randomized trial to assess the efficacy and safety of 3D-PTOBF in the treatment of patients with hepatolithiasis. We found that 3D-PTOBF offered significant improvement of immediate stone clearance ratio and stricture resolution ratio. 3D-PTOBF as a safe, effective, and promising treatment for patients with complicated primary hepatolithiasis.
