Chỉ định, kỹ thuật của phẫu thuật nội soi kết hợp nội soi đường mật và tán sỏi điện thủy lực điều trị sỏi đường mật chính

Abstract

Objective: This study is to review the indications and techniques of laparoscopic common bile duct exploration combined with cholangioscopy and electrohydraulic lithotripsy to treatment the stone in extra- and intra-hepatolithiasis. Subject and method: From May 2015 to July 2017, 111 patients with extra and intra-hepatolithiasis, who have undergone laparoscopic common bile duct exploration combined with cholangioscopy and electrohydraulic lithotripsy in Vietnamese-Swedish Uong Bi Hospital and Ho Chi Minh City Medicine and Pharmacy University were enrolled in the prospective study. Result: Indications: 71.17% patient with extrahepatolithiasis, 9.00% patient with intrahepatolithiasis, and percentage of patient with both extrahepatolithiasis and intrahepatolithiasis was 19.82%. Selective surgery was 89.19% and emergency surgery was 10.81%. Laparoscopic common bile duct exploration after failed endoscopic retrograde cholangiopancreatography in 11.71%. The proportion of patients with a history of abdominal surgery was 36.93% of which the recurrent gallstones were 16.21%. Techniques: The average number of trocars has been used 4.17 ± 0.66. Transcholedocal approach to remove stones was 89.72% and transcystic approach was 10.28%. The methods of stone removing were basket 43.93%, electrohydraulic lithotripsy 27.10% and Mirizzi 16.82%. T-tube drainage have placed into common bile duct account for 83.16% and primary closure of choledochotomy was 7.47%. Duodenal perforation occurred in 1 case during dissection and was repaired laparoscopically. Conclusion: The indications of laparoscopic common bile duct exploration combined with cholangioscopy and electrohydraulic lithotripsy in management stone in extra- and intrahepatolithiasis is being widened. This method is feasible and safe in Vietnam.