How to treat bile duct stones?

The principles of surgical treatment are as follows: ① remove stones as much as possible during operation; ② Remove bile duct stricture and obstruction, and clear the infected focus; ③ Keep bile drainage unobstructed after operation to prevent the recurrence of gallstones.

Commonly used surgical methods are as follows:

1, choledocholithotomy and T-tube drainage: it is suitable for simple bile duct stones, and the upper and lower ends of the bile duct are unobstructed without stenosis or other lesions. Cholecystectomy can be performed at the same time if accompanied by gallstones and cholecystitis. If conditions permit, intraoperative cholangiography, B-ultrasound or choledochoscope can be used to reduce the residual rate of gallstones. If the non-surgical treatment is unsuccessful and the symptoms recur or worsen, surgery is needed.

2. Common bile duct jejunostomy: also known as common bile duct jejunostomy. It is suitable for bile duct stone surgery.

(1) If the common bile duct is dilated ≥2.5cm and there are obstructive lesions such as inflammatory stenosis at the lower end, it is difficult to take it out by surgery, but the upper bile duct must be kept unobstructed without stenosis; ② Roux-en-Y cholangiojejunostomy is often used for patients with sediment-like stones, residual stones or recurrent stones that are difficult to remove.

3.Oddi sphincterotomy: the indications are the same as common bile duct jejunostomy, especially the common bile duct is slightly dilated, which is not suitable for common bile duct jejunostomy.

4, minimally invasive gallbladder-preserving lithotomy: indications: ① suitable for single gallbladder stone; ② Multiple gallstones; ③ asymptomatic gallstones; ④ Cholelithiasis with recurrent biliary colic; ⑤ No stones; ⑥ In the non-acute inflammatory stage, ⑥ bile has good sound permeability; The thickness of gallbladder wall is 0.3 ~ 0.5 cm; Pet-name ruby gallbladder contraction function after fat meal ≥ 30%; The attending patients voluntarily requested gallbladder-preserving treatment.