To evaluate the application value of maneuverable high-pressure water injection into the bile duct in percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) for complicated hepatolithiasis.

Clinical data of 11 patients with complicated hepatolithiasis admitted to Meizhou People's Hospital from August 2014 to September 2021 were retrospectively analyzed. Among them, 6 patients were male and 5 female, aged (61±9) years on average. 3 cases of choledocholithiasis were complicated with the left and right hepatic duct stones, 2 cases of choledocholithiasis complicated with the right hepatic duct stones,1 case of choledocholithiasis complicated with the left hepatic duct stone, 3 cases of the left and right hepatic duct stones, 1 case of the right hepatic duct stone and 1 case of choledocholithiasis, respectively. The informed consents of all patients were obtained and the local ethical committee approval was received. After 1-week drainage of bile by percutaneous transhepatic cholangiodrainage (PTCD), maneuverable high-pressure water injection into the bile duct was performed to dilate the intrahepatic bile duct, and biliary stones were removed by PTCSL. The success rate of biliary tract puncture and fistulization, stone removal rate, perioperative conditions and postoperative complications were observed.

All patients successfully completed the surgery. The average fistulization time during PTCD-guided bile duct puncture was (15±3) min, the success rate of puncture and fistulization was 100%(11/11), the operation time was (130±27) min, intraoperative blood loss was (15±14) ml, and the total length of hospital stay was (22±13) d.No abdominal hemorrhage or biliary leakage occurred after surgery. The stone clearance rate was 91%(10/11).

For patients with complicated hepatolithiasis, it is a safe and feasible approach to establisha PTCSL route by maneuverable high-pressure water injection into the bile duct.