Percutaneous choledochoscopic treatment of intrahepatic stones, including management of associated biliary stenoses.

摘要

BACKGROUND AND STUDY AIMS: Choledochoscopic lithotomy is a useful non-surgical treatment for intrahepatic stones. In patients with stenoses, the procedure often fails, and recurrence rates are high. PATIENTS AND METHODS: The efficacy and risks of choledochoscopic lithotomy using our procedure were investigated in 15 patients with intrahepatic stones, with and without strictures. Long-term follow-up results in patients after successful clearance were also reviewed. The follow-up period ranged from one month to 127 months (mean 75 months). RESULTS: Complete removal of stones was achieved in a mean of 2.0 sessions in all cases. The relationship between the number of sessions and the presence of the stenosis was not significant. One patient (6.7%) who had recurrent stones after complete clearance was successfully treated by repeat choledochoscopy. With regard to the rate of recurrence, there was no difference between patients with stenosis and those without. There was no procedure-related mortality. The rate of procedure-related complications was 6.7%. CONCLUSIONS: Choledochoscopic lithotomy for hepatolithiasis is an effective and safe procedure in most patients, even those with severe biliary stenosis. The choice of the appropriate route for lithotomy and appropriate management of stenoses offers a higher success rate and a lower rate of recurrence.