ABSTRACT
Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml (average, 70 ml), the operation time was 75-180 min (average, 120 min), and the postoperative gastrointestinal function recovery time was 24-48 h (average, 27±13 h).There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d (average, 7±1.5 d).A total of 54 cases were followed up for 3-24 months (mean, 14.8 months).All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.
ABSTRACT
Objective To discuss the value of holmium laser lithotripsy combined with choledochoscopy in the treatment of complicated common bile duct stones.Methods Under choledochoscopy,200 ?m fibre holmium laser lithotripsy of common bile duct stones was performed.The settings on the laser were 1.0 J and 10 Hz.The choledochoscope was used to access the common bile duct stones.The stones were fragmented and then extracted with irrigation or by using a basket. Results The stones were successfully removed in all the 17 cases.The duration of operation was 10~50 min(mean,20 min).Out of the 17 cases,there were 8 cases of primary closure of the common bile duct,6 cases of T-tube drainage, and 3 cases of stone removal via drainage passage.No bile duct bleeding or biliary leakage occurred after operation.Follow-up was conducted in 16 cases for 6~15 months(mean,10 months).B-ultrasonography or magnetic resonance cholangiopancreatography found no recurrent or residual stones,or bile duct stricture.Conclusions Holmium laser lithotripsy combined with choledochoscopy in the treatment of complicated common bile duct stones has advantages of minimal invasion,rapid recovery,satisfactory lithotripsy effects,simplicity of performance,and high reliability.