Abstract
We have established PTCCSL, one of the non-surgical treatment modalities for gallstones, as a safe, reliable and technically easy therapeutic procedure through improvements in PTCCSL manipulation and the developement of new devices for this technique. To date, we have performed PTCCSL in 37 cases of cholecystolithiasis and have succeeded in the removal of the stones in all cases without any serious complications. These patients required PTCCSL an average of 2.1 times, with a mean of 11.8 days being required from initial puncture of the gallbladder until stone removal. The post-treatment follow-up observation period in these cases ranged from 1 to 60 months, averaging 24.7 months. Gallbladder function returned to the pretreatment level and has continued to be good in all cases. Unfortunately, gallstones recurred in 7 cases (18.9%), although neither cancer nor polyp has been noted to occur during the post-treatment observation period. PTCCSL is less invasive than cholecystectomy, whether performed by laparotomy or under peritoneoscopic visualization, and can be performed repeatedly without much inconvenience or ill effects. However, PTCCSL is followed by relatively early recurrence in a significant proportion of cases, against which there currently are no reliable prophylactic measures available. PTCCSL is best served on those high-risk patients in whom general anesthesia is contraindicated.
