Application of Fiber Choledochoscope
Microscopic examination/stone, with indications for common bile duct exploration, among which 50 cases were complicated by common bile duct stones. Fifty cases were examined via a common bile duct incision, and eight cases were examined through the cystic duct.
Results: After common bile duct exploration and stone removal in 50 patients, residual stones were detected in 18 cases (36%). Net lithiasis extraction was successful in 16 cases. Among the eight cases examined via the cystic duct, three had stones, one case had a net gallbladder tube, and two cases had common bile duct stones that were successfully removed via the net.
Conclusion: The intraoperative application of fiber choledochoscope for examination/stone can reduce retained common bile duct stones and unnecessary negative explorations. This is a safe, simple, and effective method with clinical value.
Keywords: biliary endoscopy, operation, examination, stone, bile duct stones, patients, common bile duct exploration methods, often have a higher rate of residual stones..., and exploration of the common bile duct in patients also has quite a lot of negative results. In 1995, we applied fiber choledochoscope intraoperatively for examination/treatment of the biliary tract in 58 cases with postoperative residual stones, achieving good results in reducing and avoiding unnecessary negative explorations. Now, we report our application experience as follows.
1 Clinical Data
1.1 Average Data: This group includes 58 cases, 20 males, and 38 females, aged between 28 to 75 years old, with an average age of 53 years. Combined with gallbladder lithiasis in 47 cases, only 2 cases of bile duct stones, and 1 case of bile duct carcinoma reported.
In 1.2 Patients: Among the 58 patients, 50 cases had confirmed common bile duct stones before surgery and were treated conventionally during the operation with stone retrieval and Choledochoscopy. There were 18 cases where biliary stones remained in different parts even after the operation. Before the operation, 8 cases did not clearly have bile duct stones but had indications for common bile duct exploration, including 5 cases of bile duct dilation, 3 cases of biliary colic with a history of jaundice, and 2 patients with significant stone passage. Among these 8 patients, Choledochoscopy was performed via the cystic duct into the common bile duct, yielding positive results in 3 cases and negative results in 5 cases.
Methods: The gallbladder is free at the neck of the gallbladder and the junction of the cystic duct, which is ligated or clamped with a vascular clamp, gradually dilating the cystic duct by endoscope. If the result is negative, according to conventional methods, treatment for the gallbladder tube does not require T-tube drainage. If the result is positive, the corresponding treatment method is chosen based on the size and number of stones. If the stone is smaller and the amount is little, the gallbladder tube biliary endoscopy basket retrieves the stone. If the stone is larger or numerous, it may be necessary to open the common bile duct for stone retrieval.
1.3 Treatment Results by Common Bile Duct Incision: Among the 50 cases, 18 cases had residual stones (36%), and upon checking with the stone, 16 out of 18 cases were completely taken out, while 2 patients still had residual stones. Two cases had multiple stones in the intrahepatic bile ducts; intraoperative equipment and liner mirror alternately failed to retrieve all stones. After indwelling T-tube placement, 2-5 times of stone retrieval were conducted, and the stones were eventually cleared in all but one case where residual stones remained in the right hepatic duct due to T-tube sinus closure, preventing further clearance. The cystic duct was examined in 8 patients, with 3 having positive results. One case had gallbladder tube stones, and two cases had common bile duct stones that were completely removed. One of these cases was complicated by bile duct cancer, confirmed by transrectal biopsy.