Clinical Effect Of Percutaneous Transhepatic Rigid Choledochoscope Combined With Holmium Laser Lithotripsy In The Treatment Of Intrahepatic Cholelithiasi With Stricture

Objective: To investigate the efficacy and safety of one-time ultrasound-guided percutaneous transhepatic biliary sinus establishment combined with holmium laser lithotripsy in the treatment of hepatolithiasis with bile duct inflammatory stricture.Methods: the clinical data of 102 patients with intrahepatic cholelithiasi complicated with inflammatory bile duct stricture in our hepato-biliary-pancreatic surgery from January 2019 to January 2021 were retrospectively analyzed.51 patients who underwent one-time percutaneous transhepatic bile duct sinuses established by ultrasound,rigid choledochoscope combined with holmium laser in the treatment of intrahepatic bile duct stones complicated with stricture as the study group,and the other 51 patients of control group in the same period were performed with laparoscopic bile duct exploration and hepatic lobectomy.The stone clearance rate,removal rate of stricture bile duct,postoperative liver function,bilirubin,blood loss,postoperative biliary tract infection,recurrence of biliary stricture,biliary fistula,hospitalization time,operation time,postoperative recovery time of gastrointestinal function,long-term efficacy and patient satisfaction were compared between the two groups.Results: there was no death and serious complications in the two groups.In the control group,the total effective rate was 76.5%,the stone clearance rate was 70.6%,and the removal rate of stricture bile duct was74.5%,while in the study group,the total effective rate was 94.1%,the stone clearance rate was 94.1%,and the removal rate of stricture bile duct was 96.1%,the difference was statistically significant(P<0.05).The difference was statistically significan in operation time,biliary fistula,blood loss,recurrence of stricture bile duct,stone recurrence,biliary infection,hospitalization time,medical expenses,recovery time of postoperative gastrointestinal function,long-term efficacy and patient satisfaction between the two groups(P < 0.05).There was no significant difference in liver function and bilirubin level changes after operation(P>0.05).Conclusion: ultrasound-guided one-time percutaneous transhepatic biliary sinus,rigid choledochoscope combined with holmium laser in the treatment of hepatolithiasis with inflammatory stricture can achieve better clinical effect,and significantly reduce postoperative complications,stones and bile duct stricture recurrence,this technique is should be worthy of clinical application due to the safety and feasibility.