Experience of intraoperative application of choledochofiberscope endoscopy/stone: There were indications for common bile duct exploration in 50 cases associated with bile duct stones. Among these, there were 50 cases of bile duct incision checks and 8 cases of cystic duct checks.
RESULTS: After the common bile duct exploration opening to remove the stones and then check in 50 cases, 18 cases had residual stones, up to 36%. Intraoperatively, stones were removed in 16 cases, among the 8 cases of cystic duct checks, 3 cases had stones, one case of gallbladder duct was cleared, and two cases required cutting the common bile duct to remove the stones.
CONCLUSION: The intraoperative application of fiber choledochoscope for checking/removing stones can reduce the residual common bile duct stones and avoid unnecessary negative explorations. This is a safe, simple, and effective method with clinical value.
Keywords: biliary surgery, stone check, bile duct stones. Using conventional methods for bile duct exploration often results in a higher rate of residual stones... Among patients undergoing common bile duct exploration, there are a considerable number of negative outcomes. From October 1995 to September 2000, the application of fiber biliary endoscopy for surgery/treatment in 58 biliary patients achieved good results in reducing postoperative residual stones and avoiding unnecessary negative explorations. Now we present our application report as follows:
CLINICAL DATA:
1.1 General Information: This group consisted of 58 cases, including 20 males and 38 females, aged 28 to 75 years, with an average age of 53 years. There were 47 cases of gallbladder stones, 2 cases of simple bile duct stones, and 1 case of common bile duct cancer.
1.2 Intraoperative Situation: Among the 58 patients, 50 cases clearly had common bile duct stones. All stone surgeries used conventional methods that had already taken the stones via biliary tract endoscopy. In different parts of the biliary tract, there were still residual stones in 18 cases. Eight cases had clear bile duct stones before surgery but indicated the need for common bile duct exploration. Five cases had bile duct dilation, three cases had a history of biliary colic with jaundice, and two cases had obvious preoperative stone passage performance. For eight cases of patients, the biliary mirror entered the common bile duct through the cystic duct for checking, yielding positive results in three cases and negative results in five cases. The method was: after freeing the gallbladder, cut off the cystic duct at the junction of the gallbladder neck and cystic duct, use a biliary probe or forceps to gradually expand the cystic duct, and pass the biliary tract mirror. If the result was negative by conventional methods, handle the cystic duct without needing to place a T-tube drainage. If the result was positive, take the appropriate method based on the size and number of stones. For example, if the stones are small and few, use the choledochoscope basket to remove the stones through the gallbladder; if the stones are large in number, cut the common bile duct to extract the stones.
1.3 Treatment Outcome: Check the common bile duct incision in 50 patients, with 18 cases of residual stones (36%). Inspection and stone alternately, in 18 cases, 16 cases were completely cleared, with two cases still having residual stones. Two cases were intrahepatic bile duct stones; surgical equipment and bile mirror alternately failed to completely remove the stones. After 2 to 5 times of stone removal, T-tube indwelling was placed. One case still had residual stones in the right bile duct after T-tube removal, leading to sinus closure and inability to fully clear the stones. Eight patients checked the cystic duct, with 3 cases showing positive results, including one case of cystic duct stones, and two cases requiring cutting the common bile duct to completely remove the stones, including one patient confirmed with common bile duct cancer via biopsy. This group underwent intraoperative biliary endoscopy, with stone extraction time ranging from 10 minutes to 100 minutes. No patients experienced choledochoscope complications.
DISCUSSION:
The widely used choledochoscope provides a clear diagnosis, reduces the residual stone rate of the common bile duct during surgery, and offers an effective means to avoid unnecessary negative common bile duct explorations. From our experience with intraoperative Choledochofiberscope examination/treatment, it has the following advantages:
2.1 Biliary endoscopy combined with devices for stone removal can reduce the residual rate of bile duct stones; commonly used surgical methods have a higher residual stone rate after surgery. Liu Guoli's residual stone rate was 34.5%, while intraoperative choledochoscope reduced the residual stone rate to 7%. Although the total number of cases in this group is small, it still demonstrates its superiority. This group's choledochoscope check...