ABSTRACT
Objective To study the indications,feasibility and efficacy of rigid choledochoscopy via biliary fistula tracts to remove bile duct stones.Methods A retrospective analysis was performed on the clinical data of 86 patients with bile duct stones treated with rigid choledochoscopy via biliary fistula tracts at our hospital between November 2011 and July 2016.Patients with bile duct stones were divided into the percutaneous transhepatic cholangio drainage (PTCD) group and the T tube tract group.There were 40 patients who underwent lithotomy using rigid choledochoscopy via the PTCD tract and 46 patients who underwent choledocholithotomy using rigid choledochoscopy via the T-tube tract.A comparison was conducted to compare the duration of the procedures,the amount of perioperative bleeding,the postoperative complication rates and residual stone rates between the two groups.Results In the PTCD group,the average operation time was (77.0 ± 36.5) min,the amount of perioperative bleeding was (26.5 ± 54.1) ml,and the postoperative complication rate was 37.5 ％ (15/40).Complete lithotomy in one-stage was successful in 33 patients,and in two-stages in 1 patient.The residual stone rate was 15.0％ (6/40).In the T tube tract group,the average operation time was (82.5 ± 44.1) min,the amount of perioperative bleeding was (14.8 ± 21.0) ml,and the postoperative complication rate was 32.6％ (15/46).Complete lithotomy in one-stage was successful in 34 patients,and two-stages in 2 patients.The residual stone rate was 21.7％ (10/46).There were no significant differences in the residual stone rates,complication rates and operation time between the two groups (P ＞ 0.05).The amount of operative bleeding was significantly better in the T tube tract group than the PTCD group,(P ＜ 0.05).Conclusions There was no significant differences in the clinical efficacy in the treatment of bile duct stones using choledochoscopy either via the PTCD tract or the T tube tract group.Both approaches can be used for bile duct stones.
ABSTRACT
Objective To evaluate the treatment of postoperative bile-duct residual stones with rigid cholangioscopy. Methods Three hundred and twenty-seven cases of bile duct residual stones were treated with rigid cholangioscopy. As a route for the rigid cholangioscopy, the T-tube tract (315 cases), the U-tube tract (5 cases) and the jejunostomy tube tract of efferent limb (7 cases) were used. Results Four hundred and eighty-six rigid cholangioscopic sessions were carried out, 1.5 sessions on the average for each patient. Treatment was successful in all but one patient in whom rigid cholangioscopic access to bile duct was difficult since the T-tube tract was too long. The rate of complete removal of the stones was 95.4%. There were no serious complications. Conclusions It′s possible to pass the instrument into the common bile duct and the majority of the intrahepatic bile duct. Many of the problems associated with residual stones can be overcome by this method and good results achieved. This technique seems to be a useful new alternative in patients with difficult retained bile duct stones.