| [Objective]To investigate the effects and application values of laparoscopic choledochoscope holmium laser treatment of refractory extrahepatic bile duct stones, by compared with choledocholithotomy.[Methods]From March2012to September2013,75cases surgical treatment for extrahepatic bile duct stone from the third Hepatobiliary Surgery Department at the secend hospital of Kunming Medical University were retrospectively analyzed. Including34cases of Conventional laparotomy cholecystectomy, common bile duct stone exploration, T-tube drainage(A group), and41cases of Laparoscopic common bile duct exploration choledochoscope, holmium laser lithotripsy, cholecystectomy(B group).Patient was in supine position, cephalic raised of10°～20°,the right side of body raised of15°～30°. The surgeon standed on the left side of the patient, with one assistant standing close to the left side and the another assistant right side of the patient. TV monitoring system and Choledochoscope system were placed on the right side of patient, holmium laser was placed right behind the surgeon’s.The surgery was performed using a standardized four-port method. To access the peritoneum, a transverse, plane-by-plane incision of10cm was made above the umbilical edge. A pneumoperitoneum was created using CO2insufflation. To explore abdominal cavity, the laparoscopic was placed through a10mm Trocar.The second port(1cm) was at2cm below the xiphoid, the third port(0.5cm) was at2cm below the right costal margin at right midclavicular line, and the fourth port(0.5cm) was at2cm below the right costal margin at right anterioraxillar line. A10cm,5mm,5mm Trocar were placed as entrance of electricity coagulation hook, gallbladder grasping forceps and rinse suction tube under laparoscopic.The surgeon grasped the gallbladder neck with grasping forceps and opened serosa with electricity hook, blunt dissected the gallbladder/calot triangle, clipped the cystic duct and cystic artery, and then divided cystic artery.After exposing the common bile duct, choledochoscope was placed into it. The holmium laser fiber bursd fired to the center of stones through choledochoscope. The gallbladder was removed afer removal of all stones with stone basketA T tube was placed into the common bile duct through the port below the right costal margin at right midclavicular line.Finally, the surgeon sewed up the incisions after rinsing the surgical area, placing a abdominal drainage tube in lesser omentum through the port below the right costal margin at right anterioraxillar line, and removing Trocar.[Results]In this study all75patients were successfully operated. In the A group, there were4stone basket damaged, bleeding volume of85.3±18.6ml in surgery,9.8±2.9min for stone removal,5cases hemobilia,32.0±9.7h for anal aerofluxus after surgery,21.4±6.7d d in hospital,4cases gallstone recurrence. In the B group, there were none stone basket damaged, bleeding volume of43.2±6.5ml in surgery,4.6±1.8min for stone removal, none cases hemobilia,19.3±8.3h for anal aerofluxus after surgery,11.5±3.8d in hospital,1case gallstone recurrence.In both groups, indwelling shunt was removed3～7days after surgery, T tube was griped5～7days after. We found5cases gallstone recurrence of muddy stone3months later, and rinsed undergoing Choledochoscope, removed T tube. No death case, biliary fistula and biliary stricture was found in both groups. [Conclusions]1. Combined use of laparoscopic choledochoscope and holmium laser treatment for refractory extrahepatic bile duct is safe and feasible.2. Combined use of choledochoscope and holmium laser has better treatment effect in the treatment for refractory gallstones and no additional medical cost.3. It has a minimal trauma, less bleeding, short hospitalization time, quick recovery, good curative effect, and other advantages of minimally invasive surgery.4. The study provides certain reference and basis for widerly carrying out such surgeries in the future. |
PDF Full Text Request