METHOD FOR COMBINED TREATMENT OF CHOLEDOCHOLITHIASIS Russian patent published in 2021 - IPC A61B17/00 A61B1/00 A61B18/26 A61M25/10 

FIELD: invention relates to medicine, namely to minimally invasive surgery, endoscopy.

SUBSTANCE: 5 mm long skin incision is made in the right hypochondrium at the costal arch level. Then, under ultrasound control, puncture of the lobular duct and antegrade cholangiography are performed. A guidewire is installed intrabilliary under X-ray control; the canal is bouginaged to 8 Fr. An introducer with a diameter of 10 Fr is installed in the lumen of the lobular duct, through the port of which a video endoscope is inserted into the lumen of the bile ducts and antegrade cholangioscopy is performed. Through the channel of the video endoscope, a fiber-optic quartz cable is installed, through which a laser pulse consisting of infrared radiation Nd: YAG 1064 nm infrared radiation and 532 nm greenish radiation is supplied. The absorption of greenish radiation by the calculus makes plasma, which absorbs the infrared part; the resulting plasma produces a mechanical shock wave and destroys the calculus. Then, through the introducer, balloon cholangioplasty of the zone of the major duodenal papilla is performed, followed by bringing down the calculus fragments using Dormium basket into the duodenum lumen. After that, external cholangiostomy is performed with a Dawson-Muller drainage having a diameter of 10.2 Fr for decompression of the biliary system.

EFFECT: method allows to perform lithotripsy of calculi with a diameter of more than 30 mm, regardless of the composition and density of the calculus, to reduce the injury rate of surgical aggression due to the absence of the formation of additional surgical access and opening of the extrahepatic bile ducts, which provides a decrease in postoperative complications and mortality, to increase the effectiveness of treatment.

1 cl, 1 ex, 3 dwg