Résumé
Objective To explore the causes,prevention and treatment of common complications in stone extraction by choledochoscopy after bile duct operation.Methods The clinical data of 165 cases with complications after stone extraction by choledochoscopy in 1379 treated cases during 7 years were analyzed.Results The common unfavorable reactions of nausea,vomiting,abdominal pain and diarrhea occurred in 107 cases,and were alleviated by controlling the amount and rapidity of the infused sterilized water during choledochoscopy.Chills and fever occurred in 25 cases and were controlled by adequate T tube drainage and antibiotics.Bile duct hemorrhage occurred in 11 cases,including automatic hemostasis in 5 cases,hemostasis after infusing thrombin by T tube in 5 cases and hemostasis after infusing thrombin by vein in 1 case.Biliary fistula from sinus tract perforation occurred in 3 cases,and in these,T tube was successtully re-inserted in 1 case and T tube was inserted by reoperation in 2 cases.T-tube tract could not admit the choledochoscope in 19 cases,and were treated by re-choledochoscopy after gradual T-tube dilataton in 12 cases,but the sinus tract close to common bile duct was completely obstructed in 7 cases.Conclusions Choledochoscopic removal of retained stones is a safe procedure but unfavorable reactions and complications are not uncommon.The severe complications,such as bile duct hemorrhage and biliary fistula,should be prevented and appropriately treated.
Résumé
Objective To inverstigate the effect and safety of refractory intrahepatic and extrahepatic bile duct stones treated by choledochoscope holmium laser combined with electrohydraulic lithotripsy.Methods The cllnical data of 67 cases of postoperative intrahepatic and extrahepatic bile duct stones treated with combined endoscopic holmium laser and electrohydraulic lithotripsy were analysed retrospectively.Results After 1 to 7 times of biliary endoscopic holmium laser electrohydraulic lithotripsy treatment,65 patients had complete removal of all residual stones with the success rate of 97%,and without complications.Conclusions After holmium laser combined with electrohydraulic lithotripsy,the effect of choledochoscopic removal of intrahepatic and extrahepatic bile duct residual stones can be greatly improved It is a safe method for treatment of refractory intra-and extra-hepatic bile duct stones.