Combined Three Endoscopes In Treating Difficult Choledocholithiasis: With A Report Of 36 Cases

Objective:To discuss the treatmental methods of difficult common bile duct stones in era of minimally invasive surgery led by laparoscopy and endoscopy, to find the best combination of the three-mirror (laparoscopy, duodenoscopy, choledochofiberscope) of joint therapy in order to achieve the minimum trauma to obtain maximum therapeutic effect.Methods:Retrospective analysis of 36 cases of difficult choledocholithiasis in our hospital from Jan. 2002 to Jan.2009, all cases were treated by ENBD drainage firstly,and followed to operate by LC+ laparoscopic choledochotomy combined with choledochoscopy+primary suture.Results:In the group of 36 patients,34 operations were successful,2 cases of transit laparotomy because of severe cholecystitis caused extensive adhesions at Calot triangle and three ducts can not be identified,34 patients stone clearance rate was 100%,18 cases of postoperative fever, Xiphoid port infection in 2 cases, diarrhea in 14 cases,1 case of mild acute pancreatitis, cholangitis in 2 cases of reflux, no more than cases of abdominal hemorrhage, bile leakage and other serious complications. All patients were no significant long-term complications and stone recurrence through the reviewing by B-mode ultrasound of the hepatobiliary,pancreas and B-kidney every three months during the follow-up of the 1 to 3 years with an average of 24 months after the technique.Conclusion:For the difficult choledocholithiasis, "three mirrors" may make up jointly the insufficiencies of "a mirror" and/or "two mirrors", which brings into the effect in its collection and achieves the optimal fits and is the wound smallest method to treat this illness at presnet, certainly being affirmative in its curative.