Combination of Laparoscope, Choledochoscope, and Balloon Nasobiliary Exploration in Treatment of Cholecystolithiasis Combined with Choledocholithiasis with Small Diameter of Common Bile Duct (Report of 43 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENAn-ping , GAOYuan , LIHua-lin , HUTing , WANGJia-mu , ZHANGSheng-long , LIUJin-heng , SUOYun-sheng , LIUAn , YIBin

Department of Hepatobiliary Surgery, The Second Hospital of Chengdu City, Chengdu 610017, Sichuan Province, China;

Corresponding author：

CHENAn-ping, Email: chenanping1954@163.com

Keywords：

Common bile duct diseases; Cholelithiasis; Laparoscopy; Choledochoscope; Nasobiliary

DOI：

10.7507/1007-9424.20160055

Video：

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Objective To summarize clinical experiences of combination of laparoscope,choledochoscope,and balloon nasobiliary exploration (LCBNE) in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter (0.3-0.8 cm) of common bile duct (CBD). Methods From April 2010 to May 2015,there were 43 cases of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD underwent LCBNE,involving choledochotomy,choledochoscopic exploration,electrohydralic lithothipsy,balloon nasobiliary dilatation for removing cholelith,nasobiliary drainage,and the primary closure of incision. Results The procedure was successful in 27 cases of removing the bile duct residual stones through the choledochoscopic procedure,9 cases through the balloon nasobiliary procedure,and 7 cases were converted to endoscopic sphincterotomy for choledocholithasis.No case was converted to open CBD exploration.No case had residual stone.Bile leakage occurred in 1 case,which was cured by peritoneal drainage and nasobiliary drainage.One patient had a slight pancreatitis after operation.One patient had the stenosis of primary suture of CBD incision.Total postoperative complications rate was 7.0%(3/43).No case had perforations of intestine and bile duct,bleeding,severe pancreatitis,and death after operation. Conclusion From preliminary results of limited cases in this study,if patients are indicated,combination of LCBNE in treatment of cholecystolithiasis combined with choledocholithiasis with small diameter of CBD is safe and effective.

Citation： CHENAn-ping, GAOYuan, LIHua-lin, HUTing, WANGJia-mu, ZHANGSheng-long, LIUJin-heng, SUOYun-sheng, LIUAn, YIBin. Combination of Laparoscope, Choledochoscope, and Balloon Nasobiliary Exploration in Treatment of Cholecystolithiasis Combined with Choledocholithiasis with Small Diameter of Common Bile Duct (Report of 43 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(2): 214-217. doi: 10.7507/1007-9424.20160055 Copy

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2.	黄志强. 胆道外科基础与临床. 第2版. 北京:人民卫生出版社, 2003:3-7.
3.	李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查术中十二指肠镜下乳头狭窄切开术91例报道. 中华腔镜外科杂志:电子版, 2010, 3(5):438-442.
4.	Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc, 2007, 21(12):2317-2321.
5.	李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查即时缝合术983例报告. 中华腔镜外科杂志:电子版, 2010, 3(5):411-415.
6.	Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc, 2011, 25(4):1230-1237.
7.	郭鑫, 陈安平, 李波, 等. 腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石. 中华普外科手术学杂志:电子版, 2012, 6(1):70-75.
8.	陈心焕, 许兆祥. 胆道探查一期缝合与T管引流的疗效比较. 肝胆胰外科杂志, 2010, 22(4):327-330.
9.	王佳牧, 陈安平, 山长星, 等. 腹腔镜胆总管探查术2 161例报告. 外科研究与新技术, 2013, 2(3):152-154, 166.
10.	Zhao LD, Bie P,Wang SG, et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc, 2008, 22(7):1595-1600.
11.	索运生, 陈安平, 肖宏, 等. 腹腔镜下再次胆道手术83例报告. 中华普外科手术学杂志:电子版, 2012, 6(4):356-360.
12.	Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg, 2011, 396(1):53-62.
13.	李波, 陈安平, 索运生, 等. 腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例. 中华腔镜外科杂志:电子版, 2011, 4(1):36-40.
14.	张雷达, 别平, 陈平, 等. 腹腔镜胆道探查术后胆管一期缝合与T管引流的疗效比较. 中华外科杂志, 2004, 42(9):520-523.
15.	陈安平, 胡铤, 李华林, 等. 同期腹腔镜、胆管镜、十二指肠镜多入路治疗胆囊结石合并细径胆总管结石71例. 中国普外基础与临床杂志, 2014, 21(8):946-950.
16.	倪平志, 刘隽, 汤可立, 等. 胆总管探查术后一期缝合的临床经验及适应证探讨. 中国普外基础与临床杂志, 2011, 18(3):320-323.
17.	索运生, 张明哲, 尹思能, 等. 腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较. 中国微创外科杂志, 2006, 6(1):21-23.
18.	张启瑜. 钱礼腹部外科学. 北京:人民卫生出版社, 2006:879.
19.	杨孙虎, 侯军丽, 阿不都斯木, 等. 腹腔镜治疗胆囊结石合并肝外胆管结石临床研究. 中国普外基础与临床杂志, 2014, 21(7):872-874.
20.	所广军, 徐安, 胡海. ERCP临床应用指征探讨. 中国普外基础与临床杂志, 2011, 18(5):533-536.
21.	王健, 杜波, 胡兵. EST后近期严重并发症及其危险因素分析. 中国普外基础与临床杂志, 2010, 17(5):486-490.
22.	田大广, 黄洁, 张捷, 等. LC与EST联合应用治疗胆囊结石继发性胆总管结石. 中国普通外科杂志, 2006, 15(8):579-581.
23.	胡三元. 肝内、外胆管结石的腹腔镜处理. 中国普外基础与临床杂志, 2008, 15(10):711-713.
24.	王佳牧, 陈安平, 山长星, 等. 腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告. 外科研究与新技术, 2013, 2(3):170-172.
25.	郭鑫, 陈安平, 李波, 等. 腹腔镜联合十二指肠镜早期治疗轻型急性胆源性胰腺炎57例报告. 中华普外科手术学杂志:电子版, 2012, 6(2):196-201.
26.	李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查术1 712例. 中华腔镜外科杂志:电子版, 2010, 3(4):343-346.

1. 吴孟超, 吴在德. 黄家驷外科学. 第7版. 北京:人民卫生出版社, 2008:1797.
2. 黄志强. 胆道外科基础与临床. 第2版. 北京:人民卫生出版社, 2003:3-7.
3. 李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查术中十二指肠镜下乳头狭窄切开术91例报道. 中华腔镜外科杂志:电子版, 2010, 3(5):438-442.
4. Topal B, Aerts R, Penninckx F. Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc, 2007, 21(12):2317-2321.
5. 李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查即时缝合术983例报告. 中华腔镜外科杂志:电子版, 2010, 3(5):411-415.
6. Elgeidie AA, Elebidy GK, Naeem YM. Preoperative versus intraoperative endoscopic sphincterotomy for management of common bile duct stones. Surg Endosc, 2011, 25(4):1230-1237.
7. 郭鑫, 陈安平, 李波, 等. 腹腔镜、胆管镜同期治疗胆囊结石合并正常直径胆总管结石. 中华普外科手术学杂志:电子版, 2012, 6(1):70-75.
8. 陈心焕, 许兆祥. 胆道探查一期缝合与T管引流的疗效比较. 肝胆胰外科杂志, 2010, 22(4):327-330.
9. 王佳牧, 陈安平, 山长星, 等. 腹腔镜胆总管探查术2 161例报告. 外科研究与新技术, 2013, 2(3):152-154, 166.
10. Zhao LD, Bie P,Wang SG, et al. A randomized comparison of primary closure and T-tube drainage of the common bile duct after laparoscopic choledochotomy. Surg Endosc, 2008, 22(7):1595-1600.
11. 索运生, 陈安平, 肖宏, 等. 腹腔镜下再次胆道手术83例报告. 中华普外科手术学杂志:电子版, 2012, 6(4):356-360.
12. Zhu QD, Tao CL, Zhou MT, et al. Primary closure versus T-tube drainage after common bile duct exploration for choledocholithiasis. Langenbecks Arch Surg, 2011, 396(1):53-62.
13. 李波, 陈安平, 索运生, 等. 腹腔镜胆囊切除术术中联合十二指肠镜治疗正常直径胆总管结石158例. 中华腔镜外科杂志:电子版, 2011, 4(1):36-40.
14. 张雷达, 别平, 陈平, 等. 腹腔镜胆道探查术后胆管一期缝合与T管引流的疗效比较. 中华外科杂志, 2004, 42(9):520-523.
15. 陈安平, 胡铤, 李华林, 等. 同期腹腔镜、胆管镜、十二指肠镜多入路治疗胆囊结石合并细径胆总管结石71例. 中国普外基础与临床杂志, 2014, 21(8):946-950.
16. 倪平志, 刘隽, 汤可立, 等. 胆总管探查术后一期缝合的临床经验及适应证探讨. 中国普外基础与临床杂志, 2011, 18(3):320-323.
17. 索运生, 张明哲, 尹思能, 等. 腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较. 中国微创外科杂志, 2006, 6(1):21-23.
18. 张启瑜. 钱礼腹部外科学. 北京:人民卫生出版社, 2006:879.
19. 杨孙虎, 侯军丽, 阿不都斯木, 等. 腹腔镜治疗胆囊结石合并肝外胆管结石临床研究. 中国普外基础与临床杂志, 2014, 21(7):872-874.
20. 所广军, 徐安, 胡海. ERCP临床应用指征探讨. 中国普外基础与临床杂志, 2011, 18(5):533-536.
21. 王健, 杜波, 胡兵. EST后近期严重并发症及其危险因素分析. 中国普外基础与临床杂志, 2010, 17(5):486-490.
22. 田大广, 黄洁, 张捷, 等. LC与EST联合应用治疗胆囊结石继发性胆总管结石. 中国普通外科杂志, 2006, 15(8):579-581.
23. 胡三元. 肝内、外胆管结石的腹腔镜处理. 中国普外基础与临床杂志, 2008, 15(10):711-713.
24. 王佳牧, 陈安平, 山长星, 等. 腹腔镜、胆道镜、十二指肠镜(三镜)同期手术扩大一期缝合术应用199例报告. 外科研究与新技术, 2013, 2(3):170-172.
25. 郭鑫, 陈安平, 李波, 等. 腹腔镜联合十二指肠镜早期治疗轻型急性胆源性胰腺炎57例报告. 中华普外科手术学杂志:电子版, 2012, 6(2):196-201.
26. 李波, 陈安平, 索运生, 等. 腹腔镜胆总管探查术1 712例. 中华腔镜外科杂志:电子版, 2010, 3(4):343-346.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Combination of Laparoscope, Choledochoscope, and Balloon Nasobiliary Exploration in Treatment of Cholecystolithiasis Combined with Choledocholithiasis with Small Diameter of Common Bile Duct (Report of 43 Cases)

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