zThe clinical effect of double mirror combined with holmium laser in the treatment of huge common bile duct stones is good
Beijing Geriatric Hospital has more elderly patients,
has a long illness time,
has more basic heart and lung diseases,
But it is not considered when it is not life-threatening Surgery,
This brings huge trouble to surgery.
The magic height is one foot and the road is one zhang high. The general surgery comprehensively utilizes the existing equipment and reasonably matches, and solves the clinical problems with good results.
Patient Zhang, 83 years old, gallbladder stones , common bile duct stones, planned to undergo laparoscopic cholecystectomy, common bile duct incision, choledochoscopy exploration, and double-endoscopy combined stone extraction in August 2022. Due to the low blood pressure of the patient during the operation, it is not suitable for long-term operation. The intraoperative choledochoscopy was abandoned to remove the stones once, and only the gallbladder was removed during the operation. .
After 6 weeks, I tried to use choledochoscope to remove the stones in the common bile duct through the T tube, but the stones in the common bile duct were huge, about 1.5 cm, tightly stuck at the lower end of the common bile duct, and the stone extraction net could not remove the stones.
In the face of huge stones, the general surgery department inserted a holmium laser fiber into the choledochoscope, aimed at the stones, successfully crushed the stones, split them into small pieces, and successfully removed the common bile duct stones with a stone extraction net.
Choledochoscopy shows huge stones
Holmium laser crushes the stones Incision (EST) reduces postoperative complications and costs in elderly patients.
Experience sharing
Double mirror combination: laparoscopy + choledochoscopy
For patients with cholecystolithiasis combined with choledocholithiasis, first use laparoscopy for cholecystectomy, incision of the common bile duct, choledochoscopy for common bile duct exploration, and use of stone extraction net to remove the The method of calculi in the common bile duct allows one anesthesia to resolve two diseases, which is beneficial to the patient's postoperative recovery and cost savings.
This method is more suitable for cases with large common bile duct stones, common bile duct dilatation, , and it is difficult to resolve preoperative and postoperative duodenotomy (EST), and can completely prevent the possible occurrence of EST after EST. of retrograde biliary infection.
For huge stones, holmium laser lithotripsy is combined with holmium laser lithotripsy during or after operation, which overcomes the difficulty of removing huge stones and truly achieves minimally invasive treatment.
Introduction to General Surgery of Beijing Geriatrics Hospital
General Surgery is one of the earliest basic departments established in the hospital, covering the diagnosis of diseases of various organs of the digestive system, and is committed to comprehensive minimally invasive treatment based on laparoscopic minimally invasive surgery.
Hepatobiliary Professional Group Proficient in pancreatic cancer , liver cancer surgery, laparoscopic cholecystectomy, liver lobectomy, laparoscopic combined choledochoscopy for cholecystectomy and biliary tract exploration, laparoscopic pancreas, spleen resection; Retrograde cholangiography, sphincterotomy of the duodenal papilla, endoscopic nasobiliary drainage, biliary stent placement, and pancreatography were performed under endoscopic therapy.
Gastrointestinal professional group Widely carry out laparoscopic gastric cancer radical surgery, laparoscopic node and rectal cancer radical surgery, ultra-low rectal cancer anus-preserving surgery, laparoscopic enterostomy, laparoscopic exploration, adhesion release surgery, single-port abdominal cavity mirror and Notes surgery.
Anorectal professional group carry out rectal mucosal circumcision (PPH), selective rectal mucosal excision (TST) and other anorectal minimally invasive operations, and use various comprehensive methods to diagnose and treat perianal diseases.
carries out minimally invasive surgery as the first treatment method for tumor patients, at the same time, rationally uses the current medical advanced comprehensive treatment measures, monitors the concentration of chemotherapy drugs, and carries out molecular targeted therapy combined with gene detection , in order to achieve the goal of "precision medicine". Purpose.
For patients with inoperable advanced tumors, various minimally invasive treatments such as radiofrequency ablation, hepatic artery interventional embolization (TACE), endoscopic stenting, , etc. are carried out to reduce the pain of patients, improve the quality of life, and prolong the survival period .
"Minimally invasive" and "precision medicine" are the core and trend of the development of general surgery.
About the author: Yao Baofu, Deputy Director of General Surgery, Beijing Geriatric Hospital, Deputy Chief Physician, Doctor of Medicine. He has been engaged in clinical surgery for nearly 30 years, and is good at minimally invasive surgical treatment of general surgical diseases. He has accumulated rich clinical experience in the surgical treatment and comprehensive treatment of colorectal cancer, liver, biliary tract tumor, pancreatic cancer, breast cancer, gastric cancer, and thyroid cancer.
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