Biliary residual stones after analysis of 9 cases

[Abstract] Objective To understand the reasons of biliary residual stones after treatment and prevention methods. Biliary tract surgery stones analysis to understand the etiology of biliary calculi residual residual nine cases. The perfect checks surgery in the results of preoperative combined cholangiography and intraoperative B ultrasound examination can reduce the incidence of residual stones. residual stones can reduce the incidence of papers Download conclusion cholangiography and intraoperative B-ultrasound and preoperative related checks.

Surgery is an effective method for the treatment of biliary stones, imaging technology in recent years, endoscopic techniques, surgical techniques have improved, but after there are still a certain percentage of residual stones occurred, the paper summarizes the nine cases, the analysis report.

1 Clinical data

1.1 General Information

9 cases and 7 males and 2 females, aged 37-68 years old, with an average age of 54.2 years, five cases with jaundice, B-ultrasound: three cases prompt gallstones, five cases prompted gallstone with bile duct stones, 1 illustrates an bile duct stones, nine cases 7 routine gallbladder removal and common bile duct exploration, only two cases of cholecystectomy. 7 cases of common bile duct exploration in 5 patients underwent intraoperative cholangiography postoperative found gallstone residual time after two weeks three cases, January 1 cases, six months, two cases, three cases, the number of residual stone, one of seven cases, sediment samples stones 1 cases, two one case, the site of the residual common bile duct stones in seven cases, two cases of intrahepatic bile duct stones, stone size, sand-like stones, 0.3CM-0.5CM6 cases 0.6CM-0.8cm to prevent smoking and carbon mushrooming.

1.2 treatment results again stone surgery four cases, three cases were cured, 1 patient died of complications, cholangioscopy stone three cases were cured, two cases of asymptomatic hepatolithiasis NES treatment.

2 Discussion

The residual 2.1 biliary stones biliary stones Reasons for a variety of reasons, comprehensive information.

2.1.1 preoperative diagnosis of the site and the number of stones inaccurate this group 2 cases of B-exploration and bile duct stones, and the remaining seven cases not clear the number of bile duct stones.

2.1.2 intraoperative bile duct exploration stone is not complete four cases in this group has a relationship with this main factors: the surgeon thinking stereotype, too trust preoperative B, not a detailed exploration of common bile duct, bile duct, too thick or too small stones can not be easily clamp depletion around hepatolithiasis again into the common bile duct, surgery hemobilia affect further exploration for various reasons. cholangiography in the two cases did not undergo surgery.

2.1.3 Example line cholangiography, but did not find stones, may be related to the high concentration of the contrast agent conditions improper images or X-ray unclear related.

2.1.4 Choledochoscope lack of surgery and intraoperative ultrasound B.

2.1.5 surgeon is not enough skilled technology, failed to take the best stones. Posted on the prevention of the occurrence of residual stone free papers Download Center

2.2 biliary residual stone prevention has become increasingly standardized, we think it should several aspects

2.2.1 preoperative diagnosis accurate can not simply bile duct with or without stones, should be comprehensive application of B-CT, nuclear magnetic resonance, ERCP and cholangiography shadow studies, clear stone size, number and distribution for surgery more precise information.

2.2.2 intraoperative exploration diseases system. Touch before incision bile duct stone, the use of various types of stone clamp system, in order to be able to obtain a different location, size, and shape of the stones, try not to clip the stones broken to prevent stones residual bile duct is too thick (sometimes up to 2CM) can hand little finger into the touch, and is not easy to clamp the stones in the bile duct exploration, saline repeatedly flushing the biliary tract, and given the right pressure the small stones and Suixiao of the stones rushed out fine catheter and biliary probe through the duodenal papilla into the duodenum is a sign of biliary patency.

2.2.3 Intraoperative cholangiography is essential, can not be considered "safe" while ignoring cholangiography contrast agent concentration should not be too high, otherwise easy to cover up small stones. Conditional surgery should be applied Choledochoscope and intraoperative B- The check. Qin Fang-ming that should cholangiography, cholangioscopy and B-ultrasound as a routine [1].

2.3 residual biliary stone treatment

The residual stone treatment method should be based on the residual stone size, location, with or without T-tube treatment conditions, with or without other complications selection.

2.3.1 reoperation primary hospital if the patients with T-tube removal is often used surgical method. Combined AOSC biliary stricture should be preferred surgery, in order to handle complications.

2.3.2 duodenoscopy stone. Literature reports a success rate of 86% -91%. Apply to the T-tube, smaller stones, a smaller number of extrahepatic bile duct stones. Place the first endoscopic bile duct stenosis The ERBD tube (biliary enteric drainage support narrow segment sphincter relaxation again three months later stone most successful [2].

2.3.3 Choledochoscope stone, Choledochoscope operate through a T-tube sinus path is shorter, and can be observed, with the the rubble basket and the balloon catheter can be removed within view of most of the stones in the biliary but the T-tube placed unreasonable, sinus narrow, winding, Choledochoscope unable to enter the common bile duct surgery to place the tube so that postoperative necessary stubby straight reasonable Choledochoscope examination and treatment.

2.3.4 PTCS. Then built on the basis of the PTC, PTCD gradually in recent years, the development of a new method. Puncture, expansion, the establishment of the intrahepatic bile ducts at the outside of the channel, in the biliary endoscopic tie basket, electrohydraulic lithotripsy stone, incomparable superiority of other methods in the treatment of hepatolithiasis [3], but the right and left hepatic duct stenosis or the tertiary bile duct Choledochoscope not smooth arrival is PTCS cause of the failure.


[1] Qin Fang Ming, Zou Fusheng, endoscopic treatment of bile duct stones residual analysis of 306 cases of Chinese Practical Journal of Surgery, 2001,21 (6:353-356
[2] Zhou Wenzhong policy Hui Yi Jian Feng duodenoscope Choledochoscope treatment of common bile duct end incarcerated residual stones, ordinary Chinese Journal of Surgery 2011,02,15
[3] I Chanda Xionggong You, biliary endoscopic electrohydraulic lithotripsy treatment review biliary residual stones after 312 cases analysis, Jiujiang Medical, 2008,03 Links to free papers Download Center

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