ObjectiveTo investigate the efficacy and safety of laparoscopic cholecystectomy and common bile duct exploration(LCBDE) with biliary stent drainage or T tube drainage. MethodsThe clinical data of 68 cases of gallbladder and bile duct stones with the LCBDE by the same surgeon in our hospital from June 2008 to June 2013 were retrospectively analyzed. Twenty-two patients were treated with LCBDE and biliary stent drainage(stent drainage group), 46 patients were treated with LCBDE and T tube drainage(T tube drainage group). ResultsThe operation were successfully completed of 2 groups. The anal exhaust time, peritoneal drainage time, postoperative hospitalization time, and hospital expenses in stent drainage group were shorter or less than thoes T tube drainage group(P < 0.05). There were no significant difference in the operative time, postoperative bilirubin level, and incidences of postoperative complications between the two groups(P > 0.05). ConclusionsThe stent drainage and T tube drainage after LCBDE has its own indications. Laparoscopic common bile duct exploration and biliary stent drainage is superior to the laparo-scopic common bile duct exploration and T tube drainage.
Objective To evaluate the clinical effectiveness of ERCP/S+LC and LC+LCBDE in cholecystolithiasis and choledocholithiasis. Methods A fully recursive literature search was conducted in MEDLINE, EMbase, Cochrane Central Register of Controlled Trials in any language. By using a defined search strategy, both the randomized controlled trials (RCTs) and controlled clinical trials on comparing ERCP/ S+LC with LC+LCBDE in cholecystolithiasis and choledocholithiasis were identified. Data were extracted and evaluated by two reviewers independently. The quality of the included trials was evaluated. Meta-analyses were conducted using the Cochrane Collaboration’s RevMan 5.0.2 software. Results Fourteen controlled clinical trials (1 544 patients) were included. The results of meta-analyses showed that: a) There were no significant difference in the stone clearance rate between the two groups (RR=0.96, 95%CI 0.92 to 1.01, P=0.14); b) There were no significant difference in the residual stone rate between the two groups (OR=1.05, 95%CI 0.65 to 1.72, P=0.83); c) There were no significant difference in the complications morbidity between the two groups (OR=1.12, 95%CI 0.85 to 1.55, P=0.48); d) There were no significant difference in the mortality during follow-up visit between the two groups (RD= 0.00, 95%CI –0.03 to 0.03, P=0.84); e) The length of hospital stay in the LC+LCBDE group was shorter than that of the ERCP/S+LC group with significant difference (WMD= 1.78, 95%CI 0.94 to 2.62, Plt;0.000 1); and f) The LC+LCBDE group was superior to the ERCP/S+LC group in the aspects of procedure time and total hospital charges. Conclusion Although there aren’t differences in the effectiveness and safety between the ERCP/S+LC group and the LC+LCBDE group, the latter is superior to the former in procedure time, length of hospital stay and total hospital charges. For the influencing factors of lower quality and astable statistical outcomes of the included studies, this conclusion has to be verified with more strictly designed large scale RCTs.
【摘要】 目的 探讨腹腔镜胆总管探查一期缝合的可行性和适应证及临床价值。 方法 回顾性分析2007年7月—2010年10月72例胆管结石患者的临床资料，采用三孔法腹腔镜胆总管探查术，术中胆道镜配合胆道手术器械取石，一期缝合胆总管进行治疗。 结果 72例手术均获成功，无中转开腹，4例出现术后胆漏，经腹腔引流3~5 d治愈，无严重并发症。术后住院4~7 d（平均4.4 d）。72例均获随访，随访时间1~24个月（平均10个月）。术后1个月B型超声，未发现胆道狭窄及残余结石。 结论 腹腔镜胆总管探查术后一期缝合胆总管，安全、有效、微创效果显著，是临床微创治疗胆囊结石合并胆管结石的一种理想术式，值得临床推广应用。其关键是术中取尽结石和把握适应证，同时需要术者熟练掌握胆道镜技术及腹腔镜下胆总管切开缝合、打结等技术。【Abstract】 Objective To discuss the feasibility, indications and clinical value of laparoscopic common bile duct exploration with primary suture. Methods We analyzed the clinical data of 72 patients with biliary duct stone treated from July 2007 to October 2010. Three-port laparoscopic common bile duct exploration with primary suture was adopted; choledochoscopy and open bile duct operation instruments were used to take out the stones during the operation; and the common bile duct was treated with primary suture after operation. Results All operations were carried out successfully without any case of conversion to open operation. Bile leakage occurred in four cases and was cured with abdominal drainage tube for three to five days without any severe complications. Postoperative hospitalization time ranged from four to seven days, averaging at 4.4 days. All patients were followed up for one to 24 months (averaging at 10 months). B-mode ultrasonography examination one month after operation showed no biliary tract stricture or residual stone. Conclusions Laparoscopic common bile duct exploration with primary suture is safe, reliable, minimally invasive, more effective, and can be regarded as an ideal operative method for the treatment of cholecystolithiasis combined with biliary duct stone in clinical practices. It is worth popularizing. The key elements for a successful operation lie in completely taking out the stones and having a sound knowledge of indications. Furthermore, surgeons should master the skills in choledochoscopy techniques, laparoscopic incision, suture and ligation.
ObjectiveTo compare the effectiveness and safety of laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) with LC plus endoscopic retrograde cholangiopancreatography (ERCP) for patients with concomitant cholelithiasis and choledocholithiasis by using meta-analysis.MethodsWe searched PubMed, Cochrane Library、EMBASE, Chinese Biomedical Literature Database, Chinese Science and Technology Academic Journal, Chinese Journal Full-text Database and Wanfang database to identify relevant articles from their inception to 31 October 2018. A meta-analysis was carried out using the RevMan 5.3 software.ResultsA total of 13 RCTs were included in this meta-analysis, 747 cases received LC+LCBDE and 761 cases underwent LC+ERCP. The meta-analysis results showed that no significant difference between the LC+LCBDE group and the LC+ERCP group in terms of common bile duct (CBD) stone clearance rate [RR=0.99, 95%CI (0.95, 1.02), P=0.87] and overall complications [RR=0.94, 95%CI (0.72, 1.22), P=0.64]. The LC+LCBDE group had higher rate of postoperative bile leakage rate [RR=3.87, 95%CI (2.01, 7.42), P<0.000 1] than that LC+ERCP group. However, the LC+LCBDE group had lower rate of postoperative pancreatitis [RR=0.28, 95%CI (0.14, 0.55), P=0.002] than that LC+ERCP group.ConclusionsBoth LC+LCBDE and LC+ERCP are equivalent in CBD stone clearance rate and overall complications, LC+LCBDE is associated with a higher postoperative bile leakage rate and lower rate of postoperative pancreatitis, appropriate treatment should be selected according to the individual patient’s condition.
目的比较腹腔镜胆囊切除联合胆总管探查术（LC＋LCBDE）与内镜下Oddi括约肌切开取石联合腹腔镜胆囊切除术（EST＋LC）治疗胆囊结石合并肝外胆管结石的临床疗效。 方法回顾性分析45例行LC＋LCBDE及60例行EST＋LC患者的临床资料，观察2组在单次结石清除率、中转手术率、手术并发症、住院时间等指标方面的效果。 结果2组患者的基线资料相近，无手术死亡病例；2组术后并发症发生情况的差异无统计学意义（P＞0.05）；LC＋LCBDE组单次治疗成功率高于EST＋LC组，而住院时间及中转手术率则短于或低于EST＋LC组（P＜0.05）。 结论LC＋LCBDE是治疗胆囊结石合并肝外胆管结石患者安全有效的方法。
Objective To explore clinical effect of primary suture following laparoscopic common bile duct exploration (LCBDE) in treatment of patients aged over 70 years old with common bile duct (CBD) stones. Methods The clinical data of 62 patients aged over 70 years old with CBD stones underwent the LCBDE from January 2013 to December 2016 were retrospectively analyzed. Among them, 30 patients underwent the T tube drainage (T tube drainage group) and 32 patients underwent the primary suture (primary suture group) following the LCBDE. The intraoperative and postoperative statuses of these two groups were compared. Results There were no significant differences in the gender, age, body mass index, preoperative comorbidities and ASA classification, number and maximum diameter of CBD stone, and diameter of CBD between the two groups (P>0.05). There were no significant differences in the operative time, hospitalization cost, rates of total postoperative complications and readmission between the two groups (P>0.05). Compared with the T tube drainage group, the amount of intraoperative bleeding was less (P<0.05) and the postoperative hospital stay was shorter (P<0.05) in the primary suture group. Conclusion Primary suture is safe and feasible following LCBDE for patients aged over 70 years old with CBD stones in case of strict indications and proficiency intraoperation and it is more beneficial to recovery of patient.
ObjectiveTo explore how to select the suitable indications of ERCP for clinical diagnosis and treatment. MethodsThe data of patients treated by ERCP between January 2005 and December 2009 in our hospital were analyzed retrospectively. ResultsTotal 221 patients received ERCP, among whom 99 (45%) cases of common bile duct stones, 44 (20%) cases of malignant tumor, 9 (4%) cases of papilla narrow, 45 (20%) cases were negative, and 24 (11%) cases were failed. It had the trend that the number of the patients received ERCP reduced year by year. The postoperative complication rate was 11% (25 cases), including 15 cases of postoperative pancreatitis, 3 cases of bleeding, 5 cases of biliary duct infection, and 2 cases of basket stranded. ConclusionIn the modern medical condition, with the advancement of image and laparoscopy technology, we should select the diagnosis and treatment methods with the principles of no damage or less damage for patients, without unlimitedly broadening the clinical indications of ERCP.
目的：总结运用腹腔镜胆总管探查术的治疗经验。方法：回顾性分析1992年3月～2006年12月运用腹腔镜胆总管探查术对1221例患者进行治疗的经验。结果：即时缝合671例中634例和T管引流550例中501例治疗获得成功。中转开腹9例，胆漏46例，术后残余结石内镜未取净11例，死亡5例。结论：只要选择合适的病例，腹腔镜胆总管探查术对于有较高内镜和腹腔镜技术者是可行、有效和安全的。