Exploration Of Bile Dut By Chl Edochoscope Through Cystie Duct Through Mini-incision

Objective:Common bile duct exploration is often needed in small incision(MC)(3-4cm)cholecystectomy.In the past,large incision(OC)(8-10cm)was used to explore the common bile duct,then extrahepatic bile duct was explored.Ascaris or calculi were removed and T-tube drainage was placed.This method not only needs to enlarge the incision,but also needs to open the common bile duct and install T-tube drainage,which increases the incidence of trauma and bile duct retrograde infection,bile duct stenosis,cholangitis and other complications,resulting in electrolyte disturbance caused by long-term tube-carrying and the risk of bile leakage during extubation,and brings great inconvenience to patients’ lives.Choledochoscopic cholangiolithotripsy through the cystic duct under a small incision can effectively prevent such problems,not only does not need to expand the incision to increase the trauma,but also does not need to open the common bile duct and place T-tube to ensure that the common bile duct is not damaged greatly while exploring.To explore and analyze the clinical effect of choledochoscopic exploration and lithotripsy through cystic duct through small incision(MC).Method:A retrospective analysis was made of 166 patients who underwent small incision(3-4cm)choledochoscopic bile duct exploration and lithotripsy in our hospital from June2013 to June 2018.All patients met the indications of bile duct exploration and lithotripsy.130 patients underwent choledochoscopic bile duct exploration and lithotripsy without T-tube.Another 36 patients underwent choledochotomy and T-tube placement.After cholecystectomy,the long cystic duct should be retained as long as possible,dilated with bent forceps,and the choledochoscope should be sent into the common bile duct through the cystic duct.First,whether there are stones in the common hepatic duct and the branches of the left and right hepatic ducts,and then the common bile duct and nipples should be explored to remove stones or ascaris.Stone removal should be checked repeatedly for residual stones.Routine 3/0 absorbable suture was used to ligate or suture cystic duct.Result:In 166 cases of small incision cholecystectomy combined with exploration of common bile duct,36 cases were treated with exploration of common bile duct and T tube placement,and 130 cases were treated with exploration of common bile duct by choledochoscope.In 130 cases of common bile duct exploration,25 cases were negative and 105 cases had common bile duct stones.Cholecystolithiasis with acute cholecystitis and choledocholithiasis were found in 26 cases,bile duct stones with acute cholangitis in 5cases,choledocholithiasis in 14 cases,and choledocholithiasis in 14 cases.After dilation of cystic duct or micro-incision of cystic duct entrance,all the stones were removed successfully.The number of stones ranged from 1 to 10,with diameters ranging from 2mm to 11 mm,with a clearance rate of 100%.No common bile duct stones were found by preoperative imaging,32 cases by intraoperative exploration,18 cases by intraoperative choledochal dilatation with cystic duct dilatation,and 11 cases by intraoperative incision of the septum at the junction of the cystic duct and the common bile duct.Postoperative complications included pancreatitis in 6 cases,mild elevation of serum amylase(ASM less than 500 U/L)in 10 cases,and elevation of alanine aminotransferase(AST more than 100U/L)in 16 cases,all of which returned to normal after short-term treatment.During hospitalization,patients had no serious consequences such as bile leakage,residual bile duct stones and death.After 7 to 15 days of hospitalization,patients were discharged,with an average hospitalization time of 9.5 days.No bile duct stricture or recurrence of common bile duct stones occurred during the follow-up period from 3 months to 5 years.Conclusion:Firstly,the application of fiberoptic cholangioscopy to explore common bile duct through cystic duct in small incision surgery can effectively prevent the problems caused by T tube placement,which has the characteristics of minimally invasive surgery.Second,innovative achievements: micro-incision of septum at the junction of cystic duct and common bile duct;application of cleaning brush for choledochoscope;application of sodium hyaluronate.Thirdly,selective operation is effective and safe,and it is a relatively reliable method of operation.