Holmium laser for inflammatory columnar bile duct stricture: a preliminary study

doi:10.3877/cma.j.issn.1674-0785.2022.12.010

Abstract

Abstract:

Objective

To assess the clinical efficacy and safety of holmium laser in inflammatory columnar bile duct stricture.

Methods

Clinical data of 78 patients diagnosed with inflammatory columnar bile duct stricture at the Department of Hepatobiliary and Pancreatic Surgery of Sichuan Provincial People's Hospital from April 2017 to April 2020 were collected, including 52 patients who underwent endoscopic treatment and 26 who underwent surgical therapy. The clinical efficacy, intraoperative manipulations, and postoperative complications of the two groups were analyzed and compared.

Results

In the endoscopic therapy group, 84 bile ducts were relieved of stricture, and 2 patients suffered hemorrhage during branch bile duct holmium laser and were converted to segmentectomy, with a total effective rate of 94.2%. The total effective rate of the surgical therapy group was 80.8%. Postoperative angiography and MRCP examination in the surgical therapy group revealed 7 bile duct stenoses in 3 patients, and the stenoses was relieved by holmium laser in the T-tube sinus. The difference in treatment was statistically significant between the two groups (P＜0.05).

Conclusion

Holmium laser in the treatment of inflammatory columnar bile duct stenosis is effective, safe, and easy to perform.

Key words: Columnar bile duct stenosis, Holmium laser, Endoscopic treatment

Dexin Li, Chengjin Mou, Fei Li, Maode Li. Holmium laser for inflammatory columnar bile duct stricture: a preliminary study[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(12): 1207-1210.

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https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I12/1207

Figures/Tables 3

References 12

1	刘政帅. 手术治疗肝胆结石合并胆管狭窄的临床效果分析 [J]. 中国实用医药, 2019, 12(14): 40-41.
2	Lou J, Hu Q, Ma T, et al. A novel approach with holmium laser ablation for endoscopic management of intrahepatic biliary stricture [J]. BMC Gastroenterol, 2019, 19(1): 172.
3	Li EL, Feng Q, Yang QP, et al. Effectiveness of hepatic parenchyma lithotomy of hepatolithiasis: A single-center experience [J]. Medicine (Baltimore), 2017, 96(10): e6134.
4	李德新, 李飞, 赵晓晨. 胆道镜联合钬激光在胆道术后肝内胆管良性狭窄的应用 [J]. 医学信息, 2019, 22(11): 96-97.
5	Nakai Y, Isayama H, Wang HP, et al. International consensus statements for endoscopic management of distal biliary stricture [J]. Gastroenterol Hepatol, 2019, 10(4): 1111-1114.
6	李德新, 李飞, 赵晓晨. 多次胆道术后复发肝内外胆管结石的微创治疗 [J]. 医学前沿, 2018, 20(8): 183-185.
7	Wen LJ, Chen JH, Chen YJ, et al. Utility of multiple endoscopic techniques in differential diagnosis of gallbladder adenomyomatosis from gallbladder malignancy with bile duct invasion: A case report [J]. World J Clin Cases, 2020, 8(2): 464-470.
8	中华医学会外科学分会胆道外科学组, 中国医院协会外科医师分会胆道外科医师委员会. 胆道镜临床应用专家知识(2018版) [J]. 中国实用外科杂志, 2018, 38(1): 21-24.
9	赵国刚, 李德新, 李强, 等. 胆道镜联合钬激光经T管窦道治疗肝内外胆管残余结石 [J]. 中国普通外科杂志, 2012, 21(8): 922-925.
10	李德新, 李强, 李飞, 等. 经皮经肝一次性窦道建立联合钬激光碎石在高龄胆管结石合并胆管狭窄患者中的应用 [J]. 中华医学杂志, 2020, 100(40): 3161-3163.
11	Warnken EM, Uder M, Stein H, et al. Transhepatic forceps biopsy after PTCD for histological assessment of bile duct stenoses or occlusions [J]. Z Gastroenterol, 2019, 57(2): 133-138.
12	李荣坤, 尚鸣异. 胆管良性狭窄的诊治现状及进展 [J]. 肝脏, 2018, 23(11): 1029-1031.

组别	显效	有效	无效	总有效率
内镜组	36（69.2）	13（25.0）	3（5.78）	49（94.2）
手术组	14（53.8）	7（26.9）	5（19.2）	21（80.8）
χ²组				7.42
P值				0.01

组别	显效	有效	无效	总有效率
内镜组	36（69.2）	13（25.0）	3（5.78）	49（94.2）
手术组	14（53.8）	7（26.9）	5（19.2）	21（80.8）
χ²组				7.42
P值				0.01

组别	肝功能异常	胆管炎	胆道出血	胆漏
内镜组	1（1.9）	7（13.4）	3（5.7）	3（5.7）
手术组	3（11.5）	3（11.5）	1（3.8）	2（7.6）
t/χ²值	4.238	2.204	2.328	0.265
P值	0.033	0.099	0.124	0.102

组别	肝功能异常	胆管炎	胆道出血	胆漏
内镜组	1（1.9）	7（13.4）	3（5.7）	3（5.7）
手术组	3（11.5）	3（11.5）	1（3.8）	2（7.6）
t/χ²值	4.238	2.204	2.328	0.265
P值	0.033	0.099	0.124	0.102

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[13]	Zhongxiao Yan. Comparative study on transurethral holmium laser resection and plasmakinetic resection in treatment of benign prostatic hyperplasia in elderly patients [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(03): 42-45.
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[15]	Xiaolu Shi, Yuanyuan Nian, Xianmei Meng. Endoscopic treatment of gastroesophageal reflux disease [J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2023, 10(01): 38-41.

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