Clinical Analysis Of Laparotomy Under Choledochoscope With Holmium Laser Lithotripsy In The Treatment Of Complexity Biliary Calculi

Objective:To comparative the curative effect between laparotomy under choledochoscope with holmium laser lithotripsy and the traditional clinical bile duct exploration for the treatment of complexity biliary calculi.Methods:43 cases of biliary calculi were randomly divided into under choledochoscope holmium laser lithotripsy(observation group)21 cases,traditional bile duct exploration(control group)and 22 cases,compared two groups of operation time,intraoperative blood loss,hospitalization days,residual stone rate,recurrence rate and complication rate.Results:Observation group net calculi completely take 20 cases.(95.24%),operational time is(189.21 ± 23.18)min,surgical blood loss(41.75±11.62)for ml,anal exhaust time(49.1 ±7.13)h,length of hospital stay(10.64± 1.97)d,bed activity time(6.32± 1.47),no incision infection or liquefaction,pulmonary infection,biliary fistula,intestinal obstruction,postoperative residual stones in 1 case,after 2 months under choledochoscope via T tube fistula again take net stone,stone recurrence in 2 cases(9.52%).Control completely net calculi,17 cases(77.27%),surgery time is(203.16± 17.54)min,surgical blood loss(67.81±22.75)for mL,length of hospital stay(14.01 ±3.75)d,bed activity time(7.11 ±2.14),no incision infection or liquefaction,lung infection,biliary fistula,intestinal obstruction in 1 case,ostoperative residual stones in 5 case,under choledochoscope via T tube fistula lithotomy again,among them many times the microscopic lithotomy in 2 cases,again open operation in 1 case and calculi recurrence 6 cases(27.27%);In the two groups in stone net rate,operation time,intraoperative blood loss,hospital stay,bed activity time and calculi recurrence rate difference was statistically significant(P<0.05),intraoperative blood loss and calculi residual rate had significant difference(P<0.01).Observation group of gravel process without bile duct wall damage,bleeding or biliary tract perforation.Conclusions:Laparotomy under choledochoscope holmium laser lithotripsy with traditional biliary exploration results,with high security,short operation time,small surgical trauma,rapid recovery and less complications advantages,worthy of clinical popularization and application.