Use of mini-abdominal incision for choledochoscopy via cystic duct in exploration of the common bile duct:report of 135 cases / 中国普通外科杂志

Objective To evaluate the effect of mini-abdominal incision for choledochoscopy via cystic duct in exploration of the common bile duct(CBD).Methods The right subcostal incision was 4-6 cm in length.Choledochoscopy via cystic duct stump for exploration and extraction of CBD stones was done in 135 cases.Results The CBD stone was removed in 109 of 135 patients(80.7%).The CBD exploration was negative in 26 cases(19.3%)and retained CBD stones occurred in 4 cases(3.0%).One case(0.7%)had intraoperative injury of common bile duct,2 cases(1.5%)had tear of cystic duct stump,and 2 cases(1.5%)had biliary leakage,all the 5 cases were recovered after treatment.Conclusions The mini-abdominal incision with choledochoscopy via cystic duct for exploration of the CBD is safe and feasible.

Prevention and treatment of complications in choledochoscopic removal of gallstones / 中国普通外科杂志

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.

The treatment of intrahepatic bile duct stones with fiber choledochoscope combined with intraoperative ultrasound / 中国普通外科杂志

Objective To investigate the clinical significance of the treatment of intrahepatic bile duct stones with fiber choledochoscope combined with intraoperative ultrasound.Methods The clinical data of 185 cases with intrahepatic bile duct stone were analysed retrospectively,included 96 cases with stone removal by fiber choledochoscope intra-and post-operatively(choledochoscope group),and 89 cases with stone removal by fiber choledochoscope combined with intraoperative ultrasound(combined group).Results The rateo of bile duct retained stones in choledochoscope group(9.38%) was higher than that in combined group(2.08%)(P=0.041),and the rate of bile duct recurrent stones in choledochoscope group(12.34%) was higher than that in combined group(3.61%)(P=0.036).There was no significant differences between the two groups in the occarrence of cholangitis(P=0.087),but 3 cases of severe cholangitis required re-operation in choledochoscope group.Conclusions Fiber choledochoscope combined with intraoperative ultrasound can decrease the rate of bile duct retained stones and bile duct recurrent stones,and can improve the therapeutic effect.

Clinical study on choledochojejunostomy together with a subcutaneous blind loop of interposed jejunum / 中国普通外科杂志

Objective To explore the therapeutic effect of choledochojejunostomy with a subcutaneous blind loop of interposed jejunum for treating postoperative residual biliary stones.Methods The clinical data of 72 cases of choledochojejunostomy with subcutataneous blind loop of interposed jejunum were retrospectively analysed.Results After exploration of distal common bole duct,and when a No.8-10 bougie could pass through the sphincter of Oddi,a 10-15 cm segment of jejunum with its vascular pedicle was mobilized,and an end to-side choledochojejunal anastomosis was performed at the proximal side of the jejunal segment and its distal end was converted to a blind loop and fixed subcutaneously to relevant abdominal wall.A T-tube for external drainage was inserted across the choledochojejunal anastomosis and exited through the blind jejunal loop.Seventy-two patients were cured without any complication or mortality.Conclusions The procedure is simple and minimally invasive,so that it could be carried out very easily and quickly by general surgeons with basic choledochojejunostomy skill.