Clinical Application Of Grade Ⅰ To Ⅲ Choledocholithotomy Combined With Ureteral Hard Mirror Holmium Laser In The Treatment Of Diffused Hepatolithiasis

Background:Hepatolithiasis is a common and frequently occurring disease in China,while diffuse hepatolithiasis is more complicated,with a wide range of lesions,often accompanied by grade Ⅰ to Ⅲ bile duct stenosis,fibrosis of liver parenchyma,imbalance in the proportion of liver morphology,intrahepatic invagination,and diffuse distribution of stones,leading to difficult exposure,large amount of bleeding during operation,and difficult to remove stones.The combination of surgery,endoscopy and other technologies and equipment for the treatment of diffuse hepatolithiasis is the focus of clinical research.Objective:Study on the clinical application value of the first-to-third-grade choledochotomy combined with the ureteroscopic laser surgery in the treatment of the calculus of the hepatobiliary duct.Methods:Using retrospective case-control study,197 patients with diffuse hepatolithiasis from March 2016 to October 2019 in Hunan Provincial People’s hospital were selected.After operation,all patients were reexamined with full abdominal CT.95 patients with grade Ⅰ to Ⅲ intrahepatic cholangiotomy combined with ureteroscopy and holmium laser operation were included in the observation group.In addition to the operation of ureteroscopy combined with holmium laser lithotripsy,the other 102 patients with the same operation as the observation group were included in the control group.As the case may be,the control group used electronic choledochoscope to explore the bile duct,combined with stone basket and electrohydraulic lithotripsy to remove the stones.Statistical analysis of the two groups in the rate of residual stone,intraoperative bleeding,operation time,postoperative hospital stay,postoperative complications and other aspects of the difference.The measurement data were expressed by(`X±s),compared by t-test;the count data by rate(%),compared byc~2 test;P<0.05,the difference was statistically significant.Results:The residual stone rate in the observation group decreased significantly after operation:[22.11%than 34.31%,P=0.0403];The amount of blood loss during the observation group was relatively reduced:[(204.86±140.80)ml than(236.96±158.60)ml,P=0.0679],the difference is not statistically significant;The length of operation in the observation group was shortened:[(6.28±1.23)h than(6.90±0.94)h,P<0.01];In the observation group,the days of hospitalization after operation were relatively shorter[(10.80±4.51)d than(11.51±5.05)d,P=0.1503],the difference is not statistically significant;There were 9 cases(9.47%)and22 cases(21.57%)of total postoperative complications in the two groups,respectively,P=0.0198.Conclusion:Under the premise of incision of grade Ⅰ to Ⅲ bile duct,ureteroscopy and holmium laser lithotripsy can further reduce the rate of postoperative residual stones and reduce the incidence of postoperative complications of bile duct hemorrhage,and improve the surgical effect.