Exploration of treatment for common bile duct stones combined with cavernous transformation of the portal vein / 中华肝胆外科杂志

ABSTRACT

Objective To explore more safe and effective method for the treatment of common bile duct stones combined with cavernous transformation of the portal vein (CTPV).Methods We report 2 cases of post-treated patients in this series.In order to avoid severe bleeding caused by dissection of bile duct,we applied different methods to remove common bile duct stones compared with traditional operation.We removed common bile duct stones in one patient through cystic duct approach during operation.Two years later,we performed endoscopic duodenal incision (endoscopic sphincterotomy,EST) for him because of lower common bile duct stenosis with sand like stone.Another patient,on the other hand,we conducted the duodenal papilla incision during operation and removed common bile duct stones with choledochoscope through the bottom of common bile duct.Result Of the two patients,all of the three kinds of operation had good curative effects.Conclusions For the patients with common bile duct stones combined with CTPV,we should select appropriate treatments to avoid dissection of bile duct in front of the dilated and tortuous collateral veins during the operation,which is the key to guarantee the safety and success of the operation.EST is the preferred method of the treatment.Open operation with choledochoscopy via cystic duct approach or duodenal papilla incision through distal common bile duct to perform stone extraction also appears to be effective and safe.