In clinical choledocholithiasis, the main treatment is surgery, supplemented by antispasmodic, choleretic, correcting water and electrolyte balance disorders, anti-infective treatment as needed.
1. Surgical treatment: including choledochotomy, transduodenal endoscopic stone extraction, bile and intestinal anastomosis.
(1) Choledochotomy to remove stones and put to T-tube drainage according to the situation, with choledochoscopy and ultrasonography during the operation, to prevent there is a missed stone not removed. It is mainly suitable for simple common bile duct stones without stenosis or other lesions, and the bile ducts above and below the stones are clear.
(2) Transduodenal endoscopic lithotripsy is suitable for those with the number of stones less than or equal to 3 and the diameter of stones <15mm.
(3) Bile-intestinal anastomosis, applicable to the distal obstruction of the common bile duct can not be relieved, biliopancreatic duct confluence abnormality, bile ducts due to lesions or special reasons after incision can not be anastomosed.
2. Antispasmodic treatment: some antispasmodic and analgesic drugs can be taken under doctor’s guidance to relieve symptoms, such as scopolamine.
3. Choleretic treatment: when there is yellow urine, bile distension, you can take anti-inflammatory choleretic tablets, cholelithiasis tablets and so on according to the doctor’s instructions.
4. Treatment of water-electrolyte balance disorder: replenish water and electrolyte according to the specific situation, and correct acid-base balance.
5. Anti-infective treatment: antibiotics against gram-negative bacilli are mostly preferred to three-generation cephalosporin antibiotics, such as cefdinir and ceftriaxone, which should be used under the guidance of physicians.
The discovery of choledocholithiasis should be timely medical treatment, according to the location of the stone, size and other conditions and the doctor’s advice to choose a reasonable treatment program. If choledocholithiasis is in the acute stage, it should be actively anti-infective, rehydration, correction of water and electrolyte and acid-base balance disorders, and selective surgical treatment after the biliary tract infection has been controlled.