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Intrahepatic bile duct stones in patients with experience of 31 cases choledochofiberscopy

With or without residual stone. Third, the results determine the effect of reference standards Zhang L】】 to B by T tube cholangiography and ultrasound examination confirmed that no longer stones for the collection of the net. The group of 31 stone surgery'd still have residual stone after surgery with the use of fiber mirror gall stone, the stone was removed in 1O down. Mainly in the I-level calculus and the _-class hepatic duct hepatic duct. Remove the stone part of the surgery, 19 cases of grade Ⅱ stones mainly in grade I hepatic duct and hepatic duct, stone removal surgery failed in 2 cases occurred in the technologies for the early, failed because of no stones. Net and not get surgery for stone extraction failed in 21 patients with postoperative T tube fistula stone again removed in a total of 45 t l0 cases, partial removal in 8 cases, 3 cases failed. Stone removed in this group was 64.6 (20 / '31). Effective rate was 93.5 (29 / '31). Stone surgery in this group had a small amount of 4 cases of biliary tract bleeding. Almost all of stone after fistula tract, but no fistula perforation. Discussion 1. Grass-roots hospitals hepatolithiasis Intraoperative evaluation of fiber-bile Mirror: At present, China reported its residual stones after biliary tract surgery was l4 ~ 76.6L2J, and our hospital 24 cases of 19,87 to 1992 cases of hepatolithiasis analysis of postoperative residual stone in 16 cases, residual stone rate of 61.1. Such a high rate of residual stone brought many postoperative problems. Since the mirror from the use of fiber t gallbladder surgery and gallbladder surgery in the mirror fiber stone was removed in 32.3 (10/31), although there are still a high rate of residual stone, but the postoperative fistula via T tube re- stone, the total has reached the stone free rate was 64.4 (20/31), the remaining stones are generally smaller residual hepatic duct in the liver I level above the site. So that the surgical treatment of intrahepatic bile duct stones at a much higher success rate, with a tube to avoid long-term postoperative pain and trouble of unnecessary one. In addition to grass-roots hospitals, it makes us deal with intrahepatic bile duct stones in this area and shortened the gap between large hospitals. 2. Residual stone rate remains high mainly the following factors: ① multiple intrahepatic duct stones} ② gallbladder surgery using fiber mirror to time constraints; ③ and the experience of the operator concerned. We understand: net stone surgery can not take most cases of multiple intrahepatic duct stones, the stones more than the number required significantly longer operating time, and we agreed to use each patient surgery when the fiber-bile cyberspace do not mirror more than 2 hours, so as not to prolong the surgery thus when asked, to the anesthetic management of overburden. Stones removed in surgery cases, is essentially a smaller number of cases of stone. Moreover, the experience of the operator t is the first experience is not the Anhui Medical 1996 2 17 feet, operating time longer, but also concerns about some of the complications out of the stone so the small number of higher rate of residual stone . 3. Operating Experience: intraoperative use of lens fiber gall stone gall to extend operating time despite the negative factors, but it is with postoperative T tube fistula stone compared to fiber-mirror does not require long biliary fistula into the bile duct can t operation can be directly used in fiber from the bile duct incision lens insertion, and the direction of acquiring. Left hepatic duct insertion than easy - especially insert common bile duct is also very easy, but also from fistula perforation and bleeding complications. When faced with large stones. Mainly refers to the common bile duct stones larger than the diameter of large and difficult to pass because of bile duct stones, forcing the drop-down easy to cause bile duct rupture. In general, we deal first with the basket to trap the stone under direct vision after the slow, continuous traction for some time, always be successful. By feel and experience the traction, rather than blindly dead lift force, such as traction can also try hard not to tighten down the stone basket stone squeeze the t and then repeatedly washed broken stone attracts, there are winners; such as stone can not be Squeeze broken basket, remove the basket, including the prosecution in exchange for stone forceps or pliers to stone crushing, and more can be successful. But the blindness of stone forceps large, difficult to find stones, generally expected to be successful in the larger bile ducts,[link widoczny dla zalogowanych], more branches in the duct after the biopsy forceps have to rely on mirrors in the fiber under the guidance of gall bladder stone, but the gravel efficiency low, in this case we only some broken stones. Can not be removed after leaving treatment. The combined residual stenosis of bile duct stones, we first mirror by fiber biliary stone basket inserted repeatedly pulled across the stricture,[link widoczny dla zalogowanych], the stricture split, continue to move forward through the narrow section of fiber gall stone mirror. This approach can often remove most of the residual stones,[link widoczny dla zalogowanych], and correct the bile duct stricture,[link widoczny dla zalogowanych], improve function, to achieve the purpose of clinical cure
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