DSA-guided percutaneous choledocholithotomy: Opening up more opportunities for patients

Treated with modern techniques

Having epigastric pain, patient NTTL (54 years old, Ninh Hoa town) took Western and traditional medicine but it did not help, so he went to the provincial General Hospital for examination. Here, through examination, ultrasound, and CT scan, patient L. was diagnosed with stones in the common bile duct and biliary tract infection due to recurrent stones. During the time of technology transfer, patient L. was advised to undergo percutaneous nephrolithotomy under DSA guidance. After surgery, the patient's health was stable, and the symptoms of epigastric pain disappeared.

Percutaneous nephrolithotomy under DSA guidance.

Patient TMH (53 years old, Nha Trang City) came to the provincial general hospital for examination when he had signs of weight loss, pain in the right lower rib, pale yellow eyes with fatigue, and poor appetite. After being examined by a doctor and performing the necessary paraclinical tests, patient H. was diagnosed with gallstones in the liver and low common bile duct stones. Under the guidance of the DSA digital subtraction angiography system, the technical transfer team performed surgery to crush the stones, suck them out, and then wash out all the stone residue. After the surgery, the patient's health was stable and he recovered quickly. Patient H. said: "I didn't think the surgery would be so quick and gentle. The incision was very small, so there was not much pain after surgery. The doctor said I could be discharged this week."

In this transfer, 6 patients underwent surgery to crush common bile duct stones and stones in the liver. All surgeries were performed successfully. The transfer was carried out in a hands-on manner, with doctors from the Department of General Surgery performing the surgery under the direct supervision and guidance of Dr. Nguyen Thai Binh - Head of the Department of Diagnostic Imaging, Center for Diagnostic Imaging and Interventional Radiology, Hanoi Medical University Hospital, an expert in interventional radiology in the field of hepatobiliary.

Many advantages

DSA-guided percutaneous choledocholithotomy is a minimally invasive method that effectively removes stones. This is a complex technique that requires coordination between specialists and modern equipment. In this technique, under the guidance of an ultrasound machine and a DSA digital subtraction angiography system, doctors will approach through a 3-5mm skin incision into the bile duct in the liver. At the locations where stones are detected, they will be crushed, aspirated, and washed to remove all the stone residue. At the end of the lithotripsy, the patient will be re-examined by X-ray and biliary ultrasound to ensure that there are no remaining stones.

Previously, open surgery to remove intrahepatic and extrahepatic bile duct stones was the main treatment method for gallstones. Patients had to undergo major surgery with many possible complications such as bleeding, surgical site infection, slow recovery time and a very high rate of residual stones in patients with many stones, in many locations inside and outside the liver... Therefore, percutaneous nephrolithotomy under DSA guidance is considered the optimal method to help approach, completely remove, and minimize the rate of bleeding and complications. This technique can solve cases of common bile duct stones, intrahepatic stones; especially suitable for elderly patients, patients with combined systemic diseases or a history of multiple biliary tract surgeries...

Dr. Nguyen Thai Binh said: “In the past, doctors of the provincial general hospital have been thoroughly trained at Hanoi Medical University Hospital. Currently, the hospital is fully equipped with modern equipment to perform these new techniques. Therefore, the team of doctors of the provincial general hospital will soon fully master this technique in the near future and will directly treat patients in the locality.”

Dr. Nguyen Thanh Ton - Deputy Director of the Provincial General Hospital said: “DSA-guided percutaneous choledocholithiasis is a modern technique, marking a major step forward in the treatment of minimally invasive choledocholithiasis at provincial hospitals. After receiving it, the doctors of the General Surgery Department of the hospital will proactively deploy the above technique to treat patients in the province and neighboring provinces. At the same time, they will continue to study more in depth to treat difficult and complicated cases. Thereby, providing optimal, safe and more effective treatment solutions for patients”.

C.DAN

Source: https://baokhanhhoa.vn/xa-hoi/y-te-suc-khoe/202505/tan-soi-duong-mat-qua-da-duoi-huong-dan-dsa-mo-them-co-hoi-cho-benh-nhan-7fc58ac/