PTCSL二步法在合并肝硬化的肝内胆管结石治疗中的应用价值OA

Objective To evaluate the clinical application value of two-step percutaneous transhepatic cholangioscopic lithotripsy(PTCSL)in treating hepatolithiasis complicated by liver cirrhosis.Methods Clinical data of 62 patients with hepatolithiasis and liver cirrhosis who underwent PTCSL treatment at Shanghai Pudong Hospital from July 2021 to June 2025 were retrospectively collected.Based on different procedures,patients were divided into one-step PTCSL group(puncture and dialation were performed simultaneously,n=27)and two-step PTCSL group(first to puncture,then to dialate,n=35).Therapeutic efficacy and complication rates were compared between the two groups.Results Both one-step PTCSL group and two-step PTCSL group demonstrated high stone clearance rates,without statistically significant difference[22(81.48%)vs 31(88.57%),χ2=0.18,P=0.613].However,the one-step PTCSL group exhibited significantly higher overall complication rate[15(55.56%)vs 8(22.86%),χ2=6.98,P=0.008],particularly in specific complications including notable sinus tract bleeding(22.22%vs 5.71%),minor sinus tract bleeding(29.63%vs 11.43%),and biliary tract infection(11.11%vs 5.71%).Further analysis revealed that patients with decompensated cirrhosis(Child-Pugh B/C)had higher complication rates than those with compensated cirrhosis(Child-Pugh A)in both groups(all P<0.05).Among decompensated cirrhosis patients,the one-step PTCSL showed increased incidence of notable sinus tract bleeding(Child-Pugh B:23.53%vs 0;Child-Pugh C:66.67%vs 28.57%)and biliary tract infection(Child-Pugh B:11.76%vs 5.26%;Child-Pugh C:33.33%vs 14.29%)compared with the two-step PTCSL.Conclusion For hepatolithiasis complicated by decompensated liver cirrhosis,the two-step PTCSL demonstrates superior safety profile compared with one-step PTCSL.Both one-step PTCSL and two-step PTCSL are suitable for treating hepatolithiasis complicated by compensated liver cirrhosis.