| ObjectiveTo explore the clinical effect of laparoscopic and choledochoscope combined surgery in the treatment of extra-hepatic cholelithiasis.The aim is to provide reference and basis for the treatment of extra-hepatic cholelithiasis by double-mirror operation.Methods:A retrospective study was conducted to retrieve the data of two electronic medical records of extra-hepatic choledocholithiasis in Qianfushan Hospital of Shandong Province from July 2014 to October 2017.All patients with extra-hepatic cholelithiasis were selected by laparoscopy combined with choledochoscope without distinction.A total of 100 patients were included in this study.The data of the general history,the postoperative stone clearance rate,the recovery time of gastrointestinal function,the complications,and the surgical treatment of complicated cases were analyzed.According to the above data,the clinical effect of this surgical method for the treatment of extra-hepatic cholelithiasis in our hospital was evaluated and analyzed.ResultsThe success rate of double mirror surgery was 99%,of which 1 cases of extra hepatic bile duct stones were transferred to open the abdomen during operation.99 patients underwent laparoscopic combined with intraoperative choledochoscope surgery treatment of extra-hepatic bile duct stones(including 84 cases of patients with postoperative T-tube cholangiography and/or biliary endoscopy examination showed no residual stones;15 cases of patients with postoperative T-tube cholangiography and/or choledochoscopy examination revealed residual stones),and the stone clearance rate of laparoscopy combined with intraoperative choledochoscopy was 84.8%(84/99),Choledochoscopy was performed once or more after operation in 15 patients(13 cases completely removed residual stones,2 cases still had residual stones),Stone clearance rate was increased to 98.0%(97/99)after laparoscopy combined with intraoperative choledochoscopy and posto-perative choledochoscopy.Among the 2 patients who still had residual stones after choledochoscopy,1 case had lower common bile duct stenosis with stone incarceration and 1 case had postoperative choledochoscopy showing that the lower end of the common bile duct was not clear,both of them recovered after active ERCP plus IDUS plus EST plus EPBD plus ENBD treatment.Biliary leakage occurred in 2 patients(1 case due to "T" tube prolapse).There was no other visible complications happened.Of all the 100 patients,1 cases of congenital absence of gallbladder found during surgery,choledochoscopy was found in 1 cases with common bile duct stent detachment,extrahepatic bile duct stones with intrahepatic two,5 cases of three patients with bile duct stones(5 cases for the patients in laparoscopic hepatic left lateral lobectomy in 2 cases,the other 3 cases through choledochoscopy lithotripsy treatment combined with the presence of intrahepatic bile duct stones).There were 1 case with poorly differentiated adenocarcinoma of duodenal papilla,1 case with chronic inflammation of duodenal papilla mucosa.1 cases were followed up for recurrence.There were no death cases.Postoperative ventilation time 1-5 days,average(2.1 ±0.6)days;ambulation time 2-13 days,average(2.8±1.8)days;the operation time of 61-259 minutes,the average(149.4±43.9)min;intraoperative bleeding 5-300 ml,average(22.3±44)ml;T-tube retention time 9-88 days,average(40.2 ±14.3)days;hospitalization expenses 2.17-7.86 million yuan,the average(3.94±1.35)million yuan.Conclusions1.The treatment of extrahepatic bile duct stones by laparoscopy combined with choledochoscope is safe and feasible in the clinical work of hepatobiliary surgery.It is worth carrying out or further popularizing in the medical institution which has the condition to perform the operation.2.The "T" tube has sufficient decompression effect and supporting effect on the biliary system after placement."T" tube drainage can provide the opportunity for postoperative imaging and re-removal of stones by choledochoscope.3.The visual environment provided by laparoscopy combined with choledochoscope in the treatment of extrahepatic cholelithiasis and the multiple selection of surgical procedures have certain advantages in the treatment of complicated cases.4."T" tube drainage may lead to pain,"T" tube displacement or prolapse complications,postoperative long time(>6weeks),primary duct closure is the development direction of this kind of operation in the future.5.Comprehensive imaging and biochemical examination before operation,strict and careful exploration durinLaparoscopic choledochoscopy combined with intraoperative choledochoscopy for the treatment of extrahepatic cholangiolithiasis have some residual rate,and postoperative choledochoscopy can be used as an effective supplement for intraoperative choledochoscopy,thus effectively improving the postoperative stone clearance rate.The key to avoid recurrence and residual stone is to make the operation plan according to the individual condition and to manage the patients after operation. |
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