Bile duct stones are a common disease in clinical practice in China. Traditional treatment methods mainly involve open surgery, which involves cutting open the bile duct at the site of the patient's lesion and removing the stones. With the application and development of laparoscopic technology in recent years, the drawbacks of traditional open surgery, such as high trauma and difficult postoperative recovery, have become increasingly prominent. Therefore, more patients tend to prefer laparoscopic treatment. So is laparoscopy suitable for the treatment of bile duct stones? Let's take a look together below!
1、 The formation mechanism of bile duct stones
Bile duct stones are a common form of cholelithiasis in clinical practice, and can be specifically divided into intrahepatic and extrahepatic bile duct stones based on the location of the lesion. Stones located at the lower end of the common bile duct are named extrahepatic bile duct stones by the medical community, while those located in the intrahepatic bile duct are named intrahepatic bile duct stones. In addition, people also refer to stones that occur within the bile duct as primary bile duct stones. Once bile duct stones are formed, patients usually experience obvious colic and bloating pain in the upper abdomen. Some patients may also experience a certain degree of fever symptoms. If liver duct obstruction occurs, jaundice will often occur, seriously threatening the patient's health and even life. Symptomatic treatment needs to be taken in a timely manner.
2、 Laparoscopic surgery and its scope of application
Laparoscopic surgery is actually the use of laparoscopic instruments to transmit the patient's lesion location information to the system terminal for imaging. Under this guidance, the physician takes three operating holes at the corresponding positions, and then inserts the surgical instruments into the lesion location through the small holes for lesion resection and removal. It has multiple advantages such as minimal surgical trauma, fast postoperative recovery, and less risk of complications. With the upgrading and development of laparoscopic surgery technology in recent years, it has achieved greater results in the treatment of hepatic duct stones, and even became the gold standard for the treatment of benign gallbladder diseases. In the treatment of bile duct stones, the combination of fiberoptic cholangioscopy, duodenoscopy, and laparoscopy can be used for minimally invasive treatment of bile duct stones, which can achieve minimally invasive treatment of common bile duct stone removal, endoscopic sphincterotomy, and laparoscopic cholecystectomy.
Through extensive clinical practice, it has been confirmed that the indications for laparoscopic treatment techniques are roughly the same as those for traditional open surgery, mainly including the following diseases:
1. Stone removal treatment for secondary and primary common bile duct stones.
2. Primary extrahepatic bile duct stones, but bile duct stenosis needs to be ruled out. During the treatment process, cholangioscopy can be used to remove stones without the need for intraoperative bile duct shaping and internal drainage.
3. Patients with concurrent acute cholangitis or obstructive jaundice while suffering from bile duct stones, and those with a history of multiple upper abdominal surgeries. However, the risk of conversion to open surgery during laparoscopic surgery cannot be ruled out for patients in this situation. Even if laparoscopic technology is used for treatment, there are still high risks and significant surgical difficulties.
3、 Contraindications for laparoscopic treatment of bile duct stones
To fully ensure the safety of laparoscopic treatment for patients, it is necessary to clarify with the physician what contraindications exist. If the patient has poor physical function, coagulation dysfunction, or severe elective heart and lung disease, laparoscopic surgery should be avoided. At the same time, if the patient has infections combined with severe intra-abdominal adhesions, a history of previous upper abdominal surgeries, etc., the surgical method should also be carefully selected.