Abstract:

Objective

To evaluate the safety and efficacy of ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy （PTCL） in the treatment of biliary stricture after bile duct injury repair.

Methods

Clinical data of 4 patients with biliary stricture after biliary tract injury repair admitted to the First Affiliated Hospital of Jinan University from July 2021 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 2 patients were male and 2 female， aged from 44 to 62 years， with a median age of 50 years.The liver function of 4 patients was graded as Child-Pugh B.The bile duct injury was graded as Strasberg D，E1， E2 and E4， respectively.Patients experienced biliary stricture and recurrent cholangitis after biliary tract injury repair.Ultrasound-guided PTCL was adopted.Ultrasound-guided puncture was performed to establish sinus tract.Stone removal was performed by rigid choledochoscopy and stent placement was conducted.The feasibility and safety of this procedure for patients with biliary tract injury were evaluated.

Results

4 patients successfully completed the operation.Among them， biliary drainage catheter was removed after 2 cycles of treatment in 3 patients.In 1 patient， biliary drainage catheter was maintained to support the biliary duct after 1 cycle of treatment.At 3 months later， secondary operation was performed including drainage catheter replacement， biliary tract repair and residual stone removal.The follow-up time was 3.0-24.0 months， with a median follow-up time of 12.5 months.No cholangitis was reported during postoperative follow-up.

Conclusions

Ultrasound-guided PTCL can be used as one of the efficacious interventions for biliary stricture after bile duct injury repair.

Key words: Ultrasound-guided, Percutaneous transhepatic cholangioscopic lithotripsy, Biliary tract injury, Biliary stricture