Objective To investigate the techniques,safety,and efficacy of intraoperative holmium laser lithotripsy under cholangioscopic visualization for refractory intrahepatic stones. Methods A total of 38 patients with refractory hepatolithiasis underwent cholangioscopic holmium laser lithotripsy.The laser setting was: the wavelength of 2.1 ?m,the maximum mean output power of 100 W,the pulse peak power of up to 6 kW,and the laser fiber of 400 ?m in diameter.Results The stones were entirely removed on one session in all the 38 patients.The lithotripsy time was 3~5 min,the times of fragmentation was 3~8,and a total of 65 stones were fragmented.No bile duct injuries or biliary leakage happened.Cholangiography and B-ultrasonography at 2 postoperative months found no residual stones.Follow-up for 6 months found no recurrence.Conclusions Application of holmium laser lithotripsy under cholangioscopic visualization for the management of refractory intrahepatic stones is safe and effective.

Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.