CT-guided Percutaneous Choledochoscopy Combined With Dual-frequency Laser Lithotripsy To Treat Intrahepatic Bile Duct Stones

Intrahepatic bile duct stones also called hepatolith,refers to the left and right hepatic duct confluence of above of bile duct stones,incidence is higher in China,the condition is complex,often treatment is diversiform,but easy to relapse after treatment,and often merge cholangitis,diffuse hepatolith disease eventually choked bile cirrhosis,poor prognosis,is the difficulty of treatment,currently accepted liver resection is the first selection of hepatolith treatment method,but clinical common postoperative recurrence and liver function reserve insufficiency,elderly patients can’t tolerate surgery,etc.,these patients can’t tolerate surgery or will not be again,Percutaneous liver puncture choledochoscope take nephrolithotomy(PTCSL)is suitable for this kind of patient,minimally invasive,basic conditions for patients is not as high as abdominal surgery,can choledochoscope to check the stones,gravel, and correction of bile duct stricture simultaneously,and the stones of antrum repeated many times to correct narrow,for recurrent intrahepatic biliary calculi and older patients are a good choice,this study choose this kind of special type several intrahepatic biliary calculi cases,implement under CT guided percutaneous liver puncture choledochoscope combined therapy with double-frequency laser lithotripsy removed some type of intrahepatic bile duct stones,Then,the therapeutic effect was compared with that of domestic and foreign surgical treatment for intrahepatic bile duct stones,and the therapeutic effect of ct-guided percutaneous transhepatic cholangioscope combined with dual-frequency laser lithotripsy for partial treatment of intrahepatic bile duct stones was analyzed and evaluated.Purpose:To analyze and discuss the curative effect of ct-guided percutaneous transhepatic lithotripsy combined with holmium laser lithotripsy and choledochoscopy in the treatment of intrahepatic bile duct stonesMethods: Choose The First Affiliated Hospital of Nan Jing Medical University during the study general surgery in March,2015-March 2017,32 patients with intrahepatic bile duct stones,intrahepatic bile duct stone with intrahepatic bile ducts dilation,under CT guided percutaneous liver puncture catheter in the expansion of the intrahepatic bile ducts,under the guidance of thread after 2 weeks in percutaneous nephroscope fistula,with extension tube expansion into choledochoscope stone on top take stone,stone or larger stones with the aid of double-frequency laser lithotripsy after flushing suction out of the rubble,bile duct is longer than the narrow place using balloon expansion,to achieve fiber choledochoscope lens barrel can freely through,short narrow or membrane with holmium laser incision unobstructed bile duct stenosis.Then the drainage tube is indwelling.If there is a stone which cannot be completely taken once,the stone can be taken through the sinus canal twice.After the operation,b-mode ultrasound or drainage tube imaging were regularly reviewed,and no residual stones were confirmed.The perioperative complications,stone residual rate and stone recurrence rate of this operation were analyzed.The data obtained were compared with the perioperative complications,stone residue rate and stone recurrence rate reported in recent years for the partial resection of liver and gallbladder and choledochojejunostomy,to observe the treatment effect of PTCSL.Results: All the 32 patients underwent successful puncture and catheterization,while 26 patients received primary stone extraction,6 patients received secondary stone extraction,and 9 patients received dilation or incision to open the biliary tract,among which 3 patients received two or more balloon dilation to correct the bile duct stenosis.One patient underwent partial liver resection after intraoperative detection of biliary tumor.Five patients had recurrence of stones after surgery,and were treated with percutaneous liver puncture and choledochoscopic lithotomy.Two patients had acute cholangitis after surgery(among them,one had recurrence of intrahepatic bile duct restenosis and the other had recurrence).Conclusion: Research suggests: CT guided percutaneous liver puncture choledochoscope joint double-frequency laser lithotripsy removed therapy is a treatment for intrahepatic biliary calculi combined intrahepatic bile ducts dilation of the bile duct calculi of safe and effective method,especially once the relapse cases after abdominal surgery,and elderly patients can’t tolerate surgery,can avoid the damage in patients with repeated laparotomy;The effect of two-frequency laser lithotripsy is good and safe.Using balloon dilatation and holmium laser incision to correct intrahepatic bile duct stenosis in choledochoscopy is effective.