探讨经皮经肝通路诊断与治疗复杂胆道疾病的有效性和安全性。

回顾性分析南京大学附属南京鼓楼医院肝胆与肝移植外科2024年1月至2025年12月行经皮经肝诊断与治疗患者资料，观察手术达成率和并发症发生情况，胆道活检成功率、病理结果符合率和胆道结石残留率等。

16例患者接受经皮经肝通路诊断与治疗，9(9/16，56.3%)例胆道镜检查＋活检，6(6/16，37.5%)例碎石取石治疗，3(3/16，18.8%)例因胆道狭窄球囊扩张治疗，其中各有1(1/3，33.3%)例联合活检和取石。11(11/16，68.8%)例完成既定手术方案，5(5/9，55.6%)例取得组织标本，2(2/16，12.5%)例术前诊断肝门胆管癌，活检病理诊断肝细胞癌伴胆管癌栓，彻底改变治疗方案；胆道镜检查＋活检手术时间为44.2±18.0 min，球囊扩张联合支架置入手术时间为38.3±5.8 min，碎石取石手术时间为76.7±22.7 min。手术失血9.1±8.4 ml，0例患者需要输血、介入或手术止血治疗，1例患者脱入腹腔的引流管少量稀薄胆汁样液体，行经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography，ERCP)后好转，无患者因其他并发症转入监护室治疗，无患者发生肿瘤的窦道种植转移和死亡病例。

经皮经肝胆道镜直视下诊断与治疗安全可行，窦道建立是难点，建议融合多学科设备，胆道镜直视下活检为病理诊断提供可行路径。

To investigate the efficacy and safety of direct visualization diagnosis andmanagement of complex biliary diseases via percutaneous transhepatic choledochoscopy.

A retrospective cohort study was conducted on patients who underwent percutaneous transhepatic diagnostic or therapeutic procedures at the Department of Hepatobiliary and Liver Transplantation Surgery, Nanjing Drum Tower Hospital Affiliated to Nanjing University, from Jan. 2024 to Dec. 2025. Outcome measures included surgery success rate, complication incidence, biliary biopsy success rate, pathological concordance rate, and residual biliary stone rate.

A total of 16 patients were enrolled. Among them, 9 (9/16, 56.3%) underwent choledochoscopy with biopsy, 6 (6/16, 37.5%) received lithotripsy and stone extraction, and 3 (3/16, 18.8%) underwent balloon dilation for biliary stricture—with 1 (1/3, 33.3%) of the latter each group combining biopsy and stone extraction. 11 (11/16, 68.8%) patients were achieved predefined surgical plan.5 (5/9, 55.6%) cases were obtained tissue samples. Notably, 2 (2/16, 12.5%) patients preoperatively diagnosed with hilar cholangiocarcinoma were reclassified via biopsy as having hepatocellular carcinoma with biliary tumor thrombi, leading to a complete revision of their treatment regimens. Operative times varied by procedure: choledochoscopy with biopsy (44.2 ± 18.0 min), balloon dilation with stenting (38.3±5.8 min), and lithotripsy with stone extraction (76.7 ± 22.7 min). Mean intraoperative blood loss was 9.1±8.4 ml, with no patients requiring blood transfusion, interventional hemostasis, or surgical hemostasis. 1 patient developed minor bile leakage from an intra-abdominally displaced drainage tube, which resolved following endoscopic retrograde cholangiopancreatography (ERCP). No patients were transferred to the intensive care unit due to complications, and there were no cases of tumor seeding along the sinus tract and mortality case.

Percutaneous transhepatic choledochoscopy under direct visualization is a safe and feasible approach for diagnosing and treating complex biliary diseases. Sinus tract establishment remains a key technical challenge. Integration of multidisciplinary equipment is recommended, and direct-visualization biopsy via choledochoscopy provides a reliable pathway for definitive pathological diagnosis.