Endoscopic Management Analysis And Eveluation Of Refractory Choledocholithiasis

Objective:1.To explore the reasons and coping strategies of refractory choledocholithiasis.2.Retrospective analysis of the safety and efficacy of ERCP treatment for refractory choledocholithiasis.Method:To collect the refractory choledocholithiasis which the stone diameter?1.5cm,treatment in endoscope during January 2015 to December 2017 in the second affiliated hospital of kunming medical university,then retrospectively analyze the clinical data.Record ang analyze the condition of duodenal papilla,the condition of bile duct,the average operation time,the removed success rate,mechanical lithotripsy using situation,the bile duct drainage,the average length of hospital stay,and complications.Find the factors influencing the failure of take refractory choledocholithiasis.Result:1.A total of 92 patients with endoscopic refractory choledocholithiasis which the stone diameter ?1.5cm were collected.There were 30 cases of patients with papillary diverticulum,6 cases of patients papillary located in diverticulum,2 cases of duodenal papilla ectope.With distal common bile duct stenosis 19 cases,bile duct distortion in 2 cases.After subtotal gastrectomy 5cases.In our research,the patient with refractory choledocholithiasis in ERCP,the average operation time was 51.11±16.32 min,the first time success rate of stone removal was 59.78%,the second time success rate of stone removal was 91.43%,89.13%(82/92)patient use mechanical lithotripsy,complication incidence rate was 7.1%(7/92),the average length of hospital stay was 11.76 ±5.12 days.Giant choledocholithiasis(the stone diameter?2.0cm),distal common bile duct stenosis and papillary diverticulum were significant influenced the failure of take refractory choledocholithiasis(P<0.05).2.Postoperative routine ERCP lithotomy placed biliary drainage.For patients unable to take stone success at a time,we put biliary drainage for a period of time,when patient got better,we had secondary ERCP operation.There were 90 cases of patients had ENBD and 2 patient had ERBD.ENBD placed time vary from 3 to 14 days,indwelling time was 6.12± 3.98 days on average,2 cases put ERBD,one place for 3 months,another one put for 3 months.2 cases of ENBD patients occurred bile duct drainage slippage,Other patients without associated complications,like infection,slippage,hemorrhage,perforation and no death case.Conclusion:1.For endoscopic refractory choledocholithiasis with ERCP lithotomy therapy is safe and effective.2.The stone diameter?2.0cm,distal common bile duct stenosis and papillary diverticulum were significant influenced the failure of take refractory choledocholithiasis.3.The ENBD and ERBD is important auxiliary method for endoscopic refractory choledocholithiasis treatment.