Clinical Application Analysis Of Intraoperative B Ultrasonography Combined With Choledochofiberscope In Treatment Of Hepatolithiasis

Objective:To evaluate the clinical significance of the treatment of hepatolithiasis with Intraoperative B Ultrasonography Combined with Choledochofiberscope.Methods:A retrospective analysis the application of fibercholedochoscope combined with intraoperative B ultrasound (IOBUS) in treatment of hepatolithiasis was conducted in patients of our department. The clinical data of104cases with intrahepatic biliary calculi applying of fiber choledochoscope and intraoperative B ultrasound (IOBUS) from December2008to December2013were collected and retrospectively analyzed, and compared with preoperative ultrasound examination, percutaneous transhepatic cholangiography (PTC).This group includes44cases of male,60cases of female, with age beteewn23～76years old, average49.15years old.56cases were diagnosed with pure intrahepatic bile duct stones,48cases were diagnosed with intrahepatic bile duct stone combined with bile duct calculi,6patients had a history of biliary tract roundworm disease,18patients had a history of biliary tract operations (including hepatectomy,choledoclithotomy and bilioenteric anastomosis),22cases with cholangitis,9cases with acute pancreatitis,12cases with biliary stricture.Results:Among the104patients,52cases received common bile duct incision/T tube drainage assisted by intraoperative choledochoscope and intraoperative ultrasound.24cases underwent Hepatic partial resection with bile duct incision/T tube drainage,12cases had the exposure of the intrahepatic bile duct lithotomy,15cases received biliary intestinal Roux-en-Y anastomosis, and3cases were combined with the cholecystectomy. The results of Intraoperative ultrasound B in detecting intrahepatic duct stones showed sensitivity of96.36%, specificity of96.97%, accuracy of96.59%, predictive value of positive rest98.15%, and predictive value of negative test94.12%, which showed significant statistical difference compared with that of preoperative ultrasongraphy and PTC (P<0.05or0.01). Conclusion:Fiber choledochoscope combined with intraoperative ultrasound, may identify accurate distribution of intrahepatic calculi, and guide and monitor lithotomy in patients with hepatolith. Intraoperative ultrasound as a non-invasive examination, simply and clearly displaying ultrasonic image of the intrahepatic bile duct stones. The application of IOBUS could reduce the misdiagnosis or missed diagnosis of hepatic calculus, the rate of residual stone in hepatic calculus surgery and operative complications obviously, and improve the intraoperative diagnosis of hepatic calculus, thereby is helpful in the selection of appropriate surgical procedure.