Abstract:
Objective To discuss the superiority of bile duct mini-incision(BDM) technique during stone removal surgery in choledocholithiasis, and to further clarify the indications of T-tube insertion during the surgery.
Methods A total of 85 BDM operations were performed. Magnetic resonance cholangiopancreatography(MRCP), Advantage Workstation AW4.2-07sdc software, choledochoscope imaging system, and illustrations were used to clarify the indications of BDM technique in stone removal procedure.
Results The width of common bile duct (CBD) was usually more than 8mm in our choledocholithiasis cases, and the width was probably related to the number and size of the stones. In the cases with CBD width over 11 mm (16 cases), the MRCP stone imaging area (MRCP-SIA, mm2) was significantly larger compared with that (148±67 vs 47±31, P < 0.05) in the cases (14 cases) with CBD width less than 11 mm. T-tube insertion for secondary choledochoscope exam should be performed, if the stones were non-drift, multiple, and closely attached to the lower part of CBD with a difficultly complete stone removal.
Conclusions Most unnecessary T-tube insertions can be avoided by the BDM technique, especially suitable to the choledocholithiasis cases with early diagnosis. T-tube insertion is only performed in the difficultly complete stone removal and other complex cases.
Key words:
Choledocholithiasis,
Mini-incision,
T-tube drainage,
MRCP
Jian CHEN, Gang MIAO, Yao LI, Xiu-wen HE, Xiao-hua YE, Min CHEN, Jun-min WEI. Superiority of mini-incision technique in bile-duct stone removal surgery[J]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(02): 114-117.