Efficacy of choledochoscopy for the treatment of postoperative intrahepatic duct stones and strictures
10.3760/cma.j.issn.1673-9752.2013.08.014
- VernacularTitle:胆道镜治疗肝切除术后肝内胆管结石合并胆管狭窄的疗效分析
- Author:
Yuehua GUO
;
Zhuo ZHANG
;
Yang MA
;
Shiyun BAO
;
Xiaofang YU
- Publication Type:Journal Article
- Keywords:
Hepatolithiasis;
Intrahepatic duct strictures;
Choledochoscopy
- From:
Chinese Journal of Digestive Surgery
2013;12(8):616-619
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the experience of surgical management of postoperative intrahepatic duct stones and strictures with choledochoscope.Methods The clinical data of 1241 patients with intrahepatic duct stones and strictures who were admitted to the Shenzhen People's Hospital from January 2000 to December 2011 were retrospectively analyzed.All patients were divided into postoperative choledochoscopy group (652 patients were treated by choledochoscope through T-tube fistula) and conservative treatment group (589 patients were treated by cholangic and antibiotic drugs) according to treatment plan.The clinical data including stricture alleviation,incidence of complications and treatment efficacies of the 2 groups were compared using the chi-square test.Results In the postoperative choledochoscopy group,the intrahepatic duct stones of 630 patients were completely removed,with the removal rate of 96.63％ (630/652),which was significandy higher than 76.23％ (449/589) of the conservative treatment group (x2=113.407,P ＜ 0.05).A total of 1237 intrahepatic duct strictures were detected in the postoperative choledochoscopy group,including 698 cases of membranous stricture (the length of strictured bile duct ＜ 2 mm),529 cases of spool-shaped stricture (2 mm ≤ the length of strictured bile duct ≤5 mm),8 cases of long tube-shaped stricture (the length of strictured bile duct ＞ 5 mm),2 cases of crackshaped stricture.The alleviation rate of the stricture was 99.35％ (1229/1237).The conditions of 6 cases of long tube-shaped stricture and 2 cases of crack-shaped stricture were not alleviated.There were 986 cases of intrahepatic duct strictures in the conservative treatment group,and the stricture alleviation rate was 80.43％ (793/986).There was a significant difference in the stricture alleviation rate between the 2 groups (x2=238.994,P ＜ 0.05).Nine patients in the postoperative choledochoscopy group had severe complications.Five patients had intrahepatic duct hemorrhage with a volume of blood loss more than 1500 ml,and they were treated by balloon dilatation hemostasis.One patient with repeated intrahepatic duct bleeding received hepatectomy.Two patients with severe intrahepatic cholangitis received choledochoscopy.Two patients had incomplete formation of sinus and they received implantation of biliary stents under duodenoscope.Conclusion Standard surgical management with choledochoscope can effectively alleviate postoperative intrahepatic duct stones and strictures.
