To compare the effects of ultrasound-guided percutaneous transhepatic one-stage biliary fistulization (PTOBF) and percutaneous transhepatic cholangioscopy (PTCS) on stone clearance and recurrence rate in patients with complex hepatobiliary duct stones.

A total of 104 patients with complex hepatobiliary duct stones admitted to Xinhua Hospital Affiliated to Anhui University of Science and Technology from January 2021 to January 2023 were selected. Clinical data were retrospectively analyzed and divided into different surgical groups. The control group received 50 cases of PTCS surgery, while the study group received 54 cases of ultrasound-guided PTOBF surgery. The perioperative indicators, stone clearance effect, immune function, stress response, liver function, complications, and recurrence rate were compared between the two groups.

The study group had shorter postoperative exhaust time and defecation time compared to the control group (P<0.05); The study group had less intraoperative bleeding and stone removal frequency compared to the control group (P<0.05); The stone removal rate in the study group was higher than that in the control group (85.19% vs. 68.00%) (χ²=4.319, P=0.037). The levels of cortisol (Cor), adrenaline (E), and norepinephrine (NE) in both groups increased on postoperative day 1 and 3 compared to preoperative levels in the same group, and the levels of Cor, E, and NE were lower on postoperative day 3 compared to postoperative day 1 in the same group (P<0.05); One month after surgery, the levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in both groups decreased compared to preoperative levels in the same group, with the study group showing a more significant decrease (P<0.05); On the first day after surgery, the levels of CD3⁺, CD4⁺, and CD4⁺/CD8⁺ in the study group were higher than those in the control group, while the level of CD8⁺ was lower (P<0.05); There was no statistically significant difference in the incidence of complications between the two groups (22.00% vs. 16.67%) (χ²=0.475, P=0.490); The recurrence rate in the study group was lower than that in the control group (7.41% vs. 24.00%) (χ²=5.490, P=0.019).

Compared with PTCS, ultrasound- guided PTOBF surgery can effectively improve the stone removal rate in patients with complex hepatobiliary duct stones, reduce the recurrence rate, have little impact on immune function, improve liver function, shorten the postoperative recovery time of patients, and will not increase the risk of complications.