Clinical Investigation Of Holmium Laser Lithotripsy For Choledocholithiasis

ObjectiveEvaluate the clinical efficacy and safety of holmium laser lithotripsy in laparoscopic and choledochoscopic choledocholithotomy.MethodsWe conducted a retrospective study for 73 common bile duct stone patients who received surgery in our hospital between January 2011 and December 2016.All the 73 patients were divided into two groups: the 35 patients who received laparoscopic cholecystectomy and choledocholithiasis + holmium laser lithotripsy(treatment group)and the 38 patients who received laparoscopic cholecystectomy and choledocholithiasis(control group).From 2014 to 2016,patients in the treatment group underwent laparoscopic cholecystectomy+ choledocholithiasis+ holmium laser lithotripsy+ choledochofibersopic lithotomy+T tube drainage.Holmium laser was used via laparoscopic passage to smash the common bile duct stones which were then washed out by water injection or removed by a stone-retrieval basket before cholecystectomy.From 2011 to 2013,the patients in the control group received laparoscopic cholecystectomy+ choledocholithiasis+ choledochofibersopic lithotomy+T tube drainage.Data of stone-free rate after one operation,operation duration,rate of laparotomy conversion and complications,hospitalization expenses were compared between the two groups.ResultsThe stone-free rate after one procedure in the treatment group was 94.3%(33/35),compared with 86.8%(33/38)in the control group.No statistical significant differences were found between the two groups(p > 0.05).The mean operation duration was significantly shorter in treatment group than control group(104.29±12.55 min in treatment group vs(122.50±18.37)min in control group,p < 0.05).There was one case(2.9%)of conversion to laparotomy in the treatment group and 8 cases(21.1%)in the control group,showing a statistical difference(p<0.05).Two groups displayed no statistical difference in surgery complication(p > 0.05).Two cases(5.7%)--pancreatitis and bile leakage--occurred in the treatment group,while in the control group,there were three(7.9%): pancreatitis,incisional infection and bile leakage.Statistical analysis indicated a significant different in hospitalization expense(p < 0.05).Average costs in the treatment group and control group were(23517.66±4568.14)Yuan and(17071.68±3922.53)Yuan,respectively.ConclusionsCompared with laparoscopic and choledochoscopic choledocholithotomy,the combination of holmium laser lithotripsy and laparoscopic and choledochoscopic choledocholithotomy has advantages in terms of safety,clinical outcome,operative duration,conversion to laparotomy while maintains the same level of complication rate.On the other hand,its hospitalization expense is still higher than that of laparoscopic and choledochoscopic choledocholithotomy.