The Study Of The Treatment Of Intractable Liver Bile Duct Stonesunder Laparoscopy Combined Choledochoscope And Holmium Laser

Objective: To observe the clinical efficacy and the therapeutic safety of the surgery under laparoscopic common bile duct exploratione(LCBDE)combined with holmium laser forthe treatment of intractable bile duct stones.And to compare this combined method with endoscopic retrograde cholangiopancreatography(ERCP)in the treatment of extrahepatic bile duct stonesMethods: We made a retrospective analysis of the clinical data ofXX cases of intractable bile duct stones collected from June 2010 to December 2013 in our hospital(selective treatment).20 out of the total cases were treated with LCBDE combined with holmium laser.Duringthese operations,we effectively built the choledochoscope operation channel under the laparoscopy,and laid holmium laser through cholangioscopy to directly touch the bile duct stones which were then successfully crushed and finally extracted from the bile duct with basket or washed out of the bile duct in pressurized water injection.63 out of the total cases were treated with ERCP.During these operations,after ascertaining the situation of bile duct stones by inserting duodenoscope into descendant duodenum,placing the contrast tube in the duodenal papilla,and confirming the injection of contrast agent into choledoch,weextracted from the bile duct with basket or ball.Results: In 19 out of 20 cases treated with the combined method,stones were successfully removed.The operations spanned from 70-145 min,with an average of 90 min.In general,the bile duct stones were effectively removed in nearly 100%.The all of the cases showed no related complications of bile duct injuries,intraabdominal infection,bile duct haemorrhage,pancreatitis,etc.All the cases were followed up for 3 months to 2 years,who were postopratively given some auxiliary examinations like abdominal CT,color Doppler ultrasound,magnetic resonance cholangiopancreatography(MRCP),T-tube cholangiography.We did not find the postoperative complications such as residual stones.Out of 63 cases treated with ERCP,3 cases operations failed,1suffered from hematobilia,1 cases showed duodenal perforation,1 case was death,2 cases recurred with the residues of bile duct stones.Conclusion:1 The intractable bile duct stones can be effectively managed underLCBDE and holmium laser.The proper operation will not cause an obvious trauma in a patient and hurt his or her bile duct.The extraction of stones from a patient by a direct observation throughcholedochoscope will reduce the serious damage caused by the traditional laparotomy mainly carried by lithotomy and curette,and the trauma of a patient as much as possible.Thus this combined therapy has the advantages of effectively crushing stones,rapid recuperation,fewer traumas,high patient compliance,high safety,good efficacy,etc,which will open a new therapeutic approach for the treatment of bile duct stones.2 LCBDE combined with holmium laser and ERCP combined with EST are both feasible methods in the treatment of bile duct stones,both of which have their respective advantages and disadvantages.But the former can avoid the serious related complications,relieve the pain of the patients and their relatives,and reduce the medical care cost.Therefore,the majority of the intractable bile duct stones can prefer LCBDEcombined with holmium laser,and special patients can choose ERCP + EST.