The clinical application of primary sinus tract sinus establishment combined with holmium laser lithotripsy in elderly patients with choledocholithiasis and stricture

Objective: To investigate the clinical efficacy and safety of one-time percutaneous transhepatic establishment of intrahepatic bile duct sinus, choledochoscope combined with holmium laser lithotripsy in elderly patients with hepatolithiasis combined with benign stricture. Methods: The clinical data of 56 elderly patients diagnosed with intrahepatic bile duct stones combined with stricture in our hospital from January 2018 to January 2019 were collected. All patients underwent PTCD puncture and drainage, and simultaneously expanded the punctured sinus channels step by step, intrahepatic bile duct stones lithotripsy and lithotomy were performed under choledochoscope combined with holmium laser. The intraoperative operation and postoperative complications were analyzed. Results: The sinus tract was established in 53 patients, the stones were removed, and the stenosis was relieved. Two cases of puncture bleeding and 1 case of bleeding when the stenosis was relieved by holmium laser and the surgery was timely transferred. The patients received 4(2-8) times of laser lithotripsy, and it took 30(28-32) min for each treatment. The T tubules were removed when colour Doppler ultrasound and choledochography were rechecked well. The patients were followed-up for an average of 6 months with the liver function and cholerythrin recovered. Conclusion: The one-time establishment of sinus tract combined with choledochoscope holmium laser provides a new therapeutic approach for the elderly patients with hepatolithiasis and benign stricture who cannot tolerate surgery.