To evaluate the clinical efficacy of ultrasound-guided choledochoscopy via T-tube sinus in the treatment of complex intrahepatic bile duct stones.

Clinical data of 26 patients with complex intrahepatic bile duct stones admitted to Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from July 2017 to July 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 19 female, aged from 39 to 70 years with a median age of 53 years. All patients received ultrasound-guided choledochoscopic removal of bile duct stones via T-tube sinus. Intraoperatively, guide wire, balloon dilation, stone extraction basket, stone removal with flushing catheter and stone removal with drainage catheter were employed according to different situations. The effect of stone removal and incidence of postoperative complications were observed.

Among 26 patients,16 cases presented with stricture of the bile duct opening, 4 cases with acute angle between the bile duct and choledochoscope and 6 cases with distal bile duct stones. All patients successfully completed choledochoscopic stone removal with a stone removal rate 92%(24/26). Transient bleeding of biliary tract occurred in 4 patients intraoperatively, which were healed spontaneously without special treatment. Postoperative fever was observed in 6 cases and they were cured by antibiotics and symptomatic treatments. No severe complications occurred.

Ultrasound-guided choledochoscopy via the T-tube sinus is an accurate, rapid and convenient procedure, which can remove intrahepatic bile duct stones to the greatest extent and shorten the operation time. Moreover, it can be performed repeatedly for stone removal.