| Objective: To explore the merit of EST compared withorthodox modus operandi and the clinical practicality of EST for thetherapy of choledocholith.Methods: Some of the patients were treated by EST.Afterendoscopic retrograde pancreatocholangiography, cut the duodenalpapilla according to the size of stone and the length of stenosis andthen take out stone directly or after be crashed. If the cut length isnot enough, or stone can not be taken out, or bile can not run-outeasily and smoothly, or suspect residual stone, or EST can not relievethe common bile duct stricture and open operation is not suit for thepatient, endoscopic retrograde biliary drainage tube will be set in thebile duct after EST. some patient with pecholecystolithiasis andcholedocholith may excise gallbladder through laparoscope before orafter EST. The others of the patients were treated by open Operation.Open operation include Cholecystectomy and T-tube, and Theend-to-side Cholangiojejunostomy(Roux-en-Y).modus operandi wasdetermined by the condition of calculus obstruction and biliarytract. The investigation retrospecttively analysesed the managementof 139 cases of choledocholith. SPSS11.0 systems software was usedto analysis Clinical data. Patients divided into groups according todifferent index. The comparison of interclass rate apply X2 test.P<0.05 is considered to be statistical significance.Results: 47 cases were treated by EST. Cure rate of patientswith EST was 83.9%.From which 14 cases made use of endoscopicretrograde biliary drainage tube. Two cases was set endoscopicretrograde biliary drainage tube after failure of EST. from which onecase appeared to be calculus fragmentation.67 cases were treated byCholecystectomy and T-tube. Cure rate of which was 90.5%.Fivecases took a turn for the better and found residual stone after T-tubevisualization. Rate of success and residual stone of patients with ESTis obviously lower than those with Cholecystectomy and T-tube(P<0.05).10 cases were treated by Cholangiojejunostomy. cure rateof which was 100%. There are ten patients with choledocholith andcholecystolithiasis treated by EST and LC. From which one caseapplied open operation after LC because of failure of EST. one caseconverted to open operation after EST because of failure of LC. Theothers were treated by LC after EST.Analysis: The retrospective analysis demonstrate that Rate ofresidual stone of patients with EST is obviously lower than thosewith Cholecystectomy and T-tube(P<0.05), and Rate of success ofpatients with EST was 83.9%.So EST is the optimal management aslong as if only EST is fit for patient's condition. At the present,Orthodox modus operandi used to treat choledocholith with strictureof common bile duct include oddisphincterotomy and the end-to-sidecholangiojejunostomy(Roux-en-Y). Now oddisphincterotomy hasbeen raplaced gradually by EST. But if obstruction can not be treatedpartly, patients should be treated by the end-to-side cholangiojejuno-stomy. Besides ERBD tube can be used to Support the stricture ofcommon bile duct and is good to drainage bile and prevent residualstone. So patients can be well treated by EST and ERBD, that cannot be treated by end-to-side Cholangiojejunostomy. patients withcholedocholith should insist on microinvasive therapy regardless ofcholecystolithiasis, because that can retain the integrity of bilecommen duct and avoid choledochotomy and prevent fromconverting to open operation after LC for the failure of EST.Conclusion: EST is a safe and effective and Microinvasivetherapy of patients with choledocholith. Rate of residual stone ofpatients with EST is obviously lower than those withCholecystectomy and T-tube(P<0.05).Patients with choledocholithshould insist on Microinvasive therapy regardless ofcholecystolithiasis. ERBD is a supplement to EST. But some patientsstill should be treated by open operation or LCHTD after failure ofEST.
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