RESUMO
Objective To study the feasibility,superiority and curative effect of percutaneous nephrolithotomy with fibrous sheath and Swiss LithoClast Master (EMS Ⅲ) through T-tube tract for retained choledocholithiasis. Methods This study involved 32 patients with hepatolithiasis who were treated in our hospital from August 2004 to August 2007. By combining percutaneous nephrolithotomy (with a fibrous sheath on) and Swiss LithoClast Master (EMS Ⅲ) through a T-tube tract,retained choledocholithiasis was removed. Results The 32 patients totally underwent 36 operations. The mean operation time was 43 minutes (ranged from 33 to 78 minutes). In 28 of the cases,the stones were extracted completely by one session; and 2 were cured by two operations. The final stone-free rate was 94% (30/32). Follow-up was carried out in all the patients for 26 to 48 months (mean,29 months),during which no patients developed abdominal pain,jaundice or fever,no recurrence was detected by B-ultrasonography. Two patients showed residual stones after the treatment,one of them received Roux-en-Y hepatocholangioenterostomy because of extensive multiple biliary stones in the liver,which could no be removed completely after three sessions of nephrolithotomy; another patient who was a 70-year old man refused the secondary operation and thus retained a few stones in the right inferior lobe of the liver. In this series of 32 cases,no bile duct tear,massive hemorrhage,biliary leakage,cholangitis or abdominal distension occurred. Conclusions It is a safe,convenient,and simple method to combine percutaneous nephrolithotomy with Swiss LithoClast Master via T-Tube tract for retained choledocholithiasis. The procedure results in less pain in patients,and reduced equipment spoilage,while the cost is low. As the surgery is easy to perform,it is worth being widely used.
RESUMO
Electrohydraulic lithotripsy (EHL) is a method used to breakup the stone by electric discharge in the presence of liquid medium. Recently we experienced a case of successful common bile duct stone removal after EHL during choledochoscopy via T-tube tract, which was the first case of EHL in biliary tract stone in Korea. A 65-year-old female patient was admitted to our hospital because of generalized pruritus after cholcystectomy with T-tube insertion. Obtained cholangiogram showed retained CBD stone which was implssible to remove by Dormian basket and tto dissolute by monooctanoin. After only one session of EHL, we can disintergrat CBD stone into several small pieces and removal of stone was easily done by Basket. After Small cut endoscopic sphincterotomy (EST) remained distal impacted stone was freely passed and control choledochoscopy and cholangiogram showed no remained stone. We think that EHL may be play a potential role in removal of biliary tract stones as in urinary tract stones.