CURRENT TRENDS IN MANAGEMENT OF CHOLEHOLITHIASIS[在管理胆总管结石目前的趋势](-35).ppt

Management – CBD Stones Burhenne technique Treatment of retained CBD stones found on T tube cholangiography Technique modified by ERCP and sphincterotomy practice Percutaneous extraction or duodenal deposition under fluoroscopic control. Catheter –wire – contrast - balloon Approach depends on ? +/- sphincterotomy Percutaneous sphincteroplasty - alternative British Journal of SurgeryVolume 78 Issue 8,?Pages?959?-?960 Vanderburgh L, Yeung EY, Ho CS. Radiologic management of problematic biliary calculi. Sem Intervent Radiol1986; 13:69 –77 * Management – CBD Stones Percutaneous therapy is the option before resorting to surgery. Fluoroscopically-guided extraction of resident calculi through a sinus tract T tube (Kher tube) is a well-established procedure. If no T tube is in place, a transhepatic approach may be attempted. “Rendez-vous”technique. Combined percutaneous IR and endoscopic ERCPprocedure Burhenne HJ. Percutaneous extraction of retained biliary tract stones: 661 patients. AJR1980 * Rendez-vous guide-wire technique The PTC guide-wire technique seems to reduce the incidence of post-ERCP pancreatitis in the elderly as compared to the conventional contrast technique, but does not appear to improve the primary success rate for biliary cannulation during ERCP in this population. Lazaraki G, Katsinelos P. Prevention of post- ERCP pancreatitis: an overview. Ann Gastroenterol 2008; 21: 27-38. * Adjuvant Techniques with ERCP+ES Laparoscopic CBD exploration/Choleydochoscopy. Mechanical lithotripsy LASER lithotripsy Electrohydraulic lithotripsy ESWL Chemical contact dissolution therapy * Take Home Message CBD Stones associated with 10-18 % of patients undergoing cholecystectomy. Advanced endoscopic laparoscopic techniques have revolutionized management. PTC and IR (guide wire cannulation) are still successful techniques for retained stones. * U/S – Dilated CBD (14mm) containing two stones, one 13 mm. MRCP c