探讨无管化经皮经肝胆道镜取石术的可行性及临床疗效。

收集并总结2026年4月和2026年6月广州医科大学附属第一医院收治的2例肝胆管结石病患者，均接受无管化经皮经肝胆道镜取石术，分析2例患者临床一般资料、手术时间、手术方式、术中出血量、术后住院时间、术后并发症等指标。

2例患者均采用超声引导下一步法完成经皮经肝胆管穿刺并扩张窦道取石，其中1例取净结石，留置8.5 Fr胆道内支架后直接拔除经皮肝鞘管，不留置经皮经肝胆道外引流管；另1例取净结石后采用可吸收人纤维蛋白粘合剂充填封闭肝窦道，不留置胆道内支架及胆道外引流，两例患者均实现无管化经皮经肝胆道镜取石。手术操作时间90 min和70 min，术中出血量均少于10 ml，术中、术后无胆道出血，腹腔积液，胆漏等并发症，术后复查腹部CT均无结石残留。

无管化经皮经肝胆道镜取石术可一期取净结石，不留置胆道外引流管，为经皮经肝胆道镜治疗肝胆管结石病的治疗提供一种新的手术思路。

To explore the feasibility and clinical efficacy of tubeless percutaneous transhepatic cholangioscopic lithotomy.

Two patients with hepatolithiasis admitted to The First Affiliated Hospital of Guangzhou Medical University on Apr. 2026 and Jun. 2026 were enrolled in this study. Two patients underwent tubeless percutaneous transhepatic cholangioscopic lithotomy. Clinical baseline data, operative time, surgical procedures, intraoperative blood loss, postoperative hospital stay, postoperative complications of the two patients were analyzed.

Ultrasound-guided one-step percutaneous transhepatic biliary puncture and sinus tract dilation for lithotomy were performed in both patients. Complete stone clearance was achieved in one case, an 8.5 Fr biliary internal stent was placed, then the percutaneous transhepatic sheath was removed without percutaneous transhepatic biliary external drainage. In the other case, after complete stone removal, the hepatic sinus tract was sealed with absorbable human fibrin glue, with neither biliary internal stent nor external biliary drainage placed. Tubeless percutaneous transhepatic cholangioscopic lithotomy was successfully accomplished in both patients. The operative time was 90 min and 70 min, respectively. Intraoperative blood loss was less than 10 ml in both cases. No intraoperative or postoperative complications such as biliary hemorrhage, peritoneal effusion or bile leakage occurred. Postoperative abdominal CT showed no residual stones in both patients.

Tubeless percutaneous transhepatic cholangioscopic lithotomy can achieve onestage complete stone clearance without placement of percutaneous transhepatic biliary external drainage tube. It provides a novel surgical strategy for percutaneous transhepatic cholangioscopic management of hepatolithiasis.