Choledochoscopy (Cholangioscopy) and choledochoscope technology is widely used in clinic, has become the extrahepatic biliary tract disease
Choledochoscopy (Cholangioscopy) and choledochoscope technology is widely used in clinic, has become the extrahepatic biliary tract disease and special diagnosis - the most important one of the treatment methods, and has become the biliary surgery - liver surgery is one of the most important minimally invasive techniques. The most commonly used classical or choledochoscopy is applied to biliary laparotomy and biliary surgery after T/U tube fistula of hepatic bile duct exploration or removal of residual stones, which usually belong to the category of endoscopic surgery. However, with the development of minimally invasive medicine theory and minimally invasive devices - Equipment - technology, with minimally invasive methods of continuous integration and fusion, and the traditional choledochoscope technology has been a new development, to adapt to a wider range.
1 types of choledochoscopy
In general, choledochoscopy is divided into two types according to its application, namely, the endoscopic biliary tract and the standard choledochoscope. Under special circumstances, according to the actual needs, such as the need for a large working channel (2.8mm), you can choose to use fiberoptic bronchoscopy; require a more detailed mirror can be used to replace the standard choledochoscope. The endoscope is a kind of fiber endoscope with a length of 1.8~1.88m, a diameter of 3.2~4.5mm and a working channel of 0.5~1.7mm. There are two kinds of diagnostic standard and treatment type, the length of the mirror is 670mm, but the diameter of the working channel is different, the diagnosis is 2.2mm, the treatment is 2.6mm, and the operating knob is a single helix. Fiber choledochoscope, there are two kinds of optical or electronic. At present, the most widely used optical fiber mirror is the most obvious advantage of electronic choledochoscope.
2 types of choledochoscopy
According to the approach of choledochoscope, the choledochoscope and its techniques can be divided into the following six types.
 oral choledochoscopy: the advantage of this technique is to be completed by the oral route, the treatment of direct endoscopic exploration and mirror in the biliary tract, so as to avoid surgery; lack of technology is complicated to operate, very high requirements for endoscopic doctor technology. It is also the most complex digestive endoscopic surgical technique.
 after incision of choledochoscopy: usually, open biliary surgery, biliary tract exploration is through the operation of hand touch or use of biliary tract bougie. When the operation can not clear the internal bile duct, especially the intrahepatic bile duct and nipple inside the case, or to the exclusion of bile duct stones is not clean, the implementation of choledochoscope during operation will have an important value. The advantage of this technique is that it extends the surgeon's eyes during surgery, and clearly understands the condition of the biliary tract.
 laparoscopic approach of choledochoscopy: this technique is a form of choledochoscope, different places, is the choledochoscope after laparoscopic trocar into the abdominal cavity, intraoperative choledochoscopy than traditional intraoperative angiography, its accuracy is higher and can carry out some operations.
 through the fistula of choledochoscopy (T pipe, U pipe): the technique for postoperative choledochoscopy, the premise is must have the surgery and biliary fistula with indwelling.
 percutaneous transhepatic cholangioscopy Technology (PTCS): when no biliary drainage tube (T tube) failure or placing the ERCP pathway, the technology is the only way to non surgery method into the biliary tract and minimally invasive technique.
 percutaneous peritoneal cavity / parenchymatous organ necrosis endoscopic technology: the technology refers to the use of laparoscopic (of course, can also use other appropriate endoscopic, such as bronchoscopy or fiber bladder and ureter mirror), using choledochoscope technology of intraperitoneal localized foci within the parenchymal organs or focal necrosis the lesion detection and debridement.
3 indications and contraindications of choledochoscopy
In the early stage, choledochoscopy was mainly used in the exploration and the removal of residual bile duct stones after T. At present, the indications in early indications, the main indications include large common bile duct stones (conventional treatment technology of ERCP directly from stone, endoscopic mechanical lithotripsy failure can not surgery), Mirizzi syndrome, anastomotic biliary complications of hepatolithiasis, obstructive jaundice, liver, bile duct stones bile duct cancer, liver transplantation: stenosis and anastomotic stenosis of intrahepatic biliary tree - type foreign body - hepatic duct stricture hepatic necrosis, abdominal surgery, abdominal drainage impeded localized abscess formation.
The contraindication of choledochoscopy is extensive bile duct hemorrhage or necrosis of the wall.
4 recent advances in the application of choledochoscopy
Choledochoscopy is a valuable method for the minimally invasive technique of biliary disease complex, especially in recent years, under the guidance of the theory of the minimally invasive medicine, and ultrasonic endoscopic x-ray (or endoscopic ultrasonography) three kinds of minimally invasive thoughts, compared with traditional surgery, some techniques, such as choledochoscopy during the operation, is an important supplement to the surgery; but many technologies, such as peroral cholangioscopy and PTCS technique and percutaneous peritoneal / visceral necrosis in endoscopic technology, will break the traditional thinking, become the alternative technology operation method.
In order to achieve the direct detection and treatment of middle to high bile duct carcinoma, we can use the PTCS technique without surgical indications.
The liver is limited to the formation of an abscess. It is usually treated by surgery, but endoscopic techniques can be used when the patient is unable to perform surgery.
 biliary anastomotic stenosis after operation of biliary enteric anastomosis stenosis associated with hepatolithiasis and recurrent have a fever, its core is the cause of anastomotic stricture bile drainage is not smooth, or to conventional treatment (conservative treatment) or great damage (surgery). PTCS technology can be used to minimally invasive removal of stones, relieve stenosis.
[/] intrahepatic bile duct calculi in intrahepatic bile duct stones, typically, a small, stone free in the lumen, but the use of standard biliary stone basket out.
[choledocholithiasis and Mirizzi syndrome for huge stones treated by ERCP technique and the bile duct stone extraction mechanical lithotripsy failure giant bold duct stones and incarcerated in the initial part of the cystic duct and cause bile duct obstruction (Mirizzi syndrome), peroral cholangioscopy lithotripsy is broken and non operative methods relieve ureteral obstruction only effective minimally invasive technique.
[liver] biliary complications after transplantation. At present, the technology method of biliary complications after liver transplantation is limited: surgery is liver retransplantation reoperation; methods of non-surgical treatment of biliary complications, the fundamental goal is to relieve the bile flow channel of each layer on the surface of the mechanical obstruction of biliary tract and removal of foreign bodies. The complete removal of the foreign body is the first important; in this regard, choledochoscope technology is currently the treatment of biliary complications is one of the options, but also effective and minimally invasive technique.
[abdominal visceral perforation peritoneal localized abscess formation is a very rare case, such as abdominal hollow viscera perforation, multiple surgical repair failure after intraperitoneal local formation of localized infection foci, conventional silicone tubes or "cigarettes drainage tube drainage unobstructed but with infection symptoms (high blood, high temperature fast rhythm, etc.), no indications for surgery, can use choledochoscopy, drainage, the local: exploration, washing and removal of necrotic foreign bodies (endoscopic debridement).