Situation of Operative Treatment of Common Bile Duct Stone in Phayakkhaphum Phisai Community Hospital-สถานการณ์การรักษานิ่วในท่อน้ำดีด้วยการผ่าตัดในโรงพยาบาลชุมชนพยัคฆภูมิพิสัย

Abstract

            Nowaday, there is a new technique to treat commom bile duct stone by using endoscopic sphincterotomy with stone extraction or lithotripsy.  This technique requires skillful surgeons and costly instruments such as duodenoscope, sphincterotome, stone basket and fluoroscope.  All are available only in advanced medical institutes.  Because of acute abdominal pain and cholangitis the most chief complaints, most patients  prefer immediate and short treatment time.

             Phayakkhaphum Phisai hospital is a community hospital with good surgical team and basic surgical instruments for common bile duct stone surgery.  There were 47 patients treated in the hospital from January, 2001 to December, 2004.  After the operative exploration of common bile duct and stones removal, T-tubes were inserted in 15 patients, 32 patients had open and drain bile to small bowel by many enterobiliary drainage procedures such as choledochoduodenostomy, choledochojejunostomy, transduodenal sphincteroplasty.

             This study reported the results, recurrent symptoms and also the complications within 2 year follow-up after surgery.  The results were reportedly excellent, without mortality, serious immediate complications and recurrent symptoms in the 2 year follow-up after surgery except a case of acute cholangitis fourteen months after choledochoduodenostomy.

Key words:   common bile duct stone,endoscopic sphincterotomy with stone extraction,common bile duct exploration, enterobiliary drainage procedure