Histological studies and morphometry quantitative analysis have been performed on trial rabbit’s dilated common bile duct(CBD),which does not dilate simultaneously.The results shows:①Epithelia of rabbit’s CBD have a ber reparable function,which is fairly significant to the prevention of bile duct’s further injure under the pathogenic situation.②The smooth muscle cell(SMC)of the CBD is the histological basis of contraction,some SMC can be seen in contracting state under light microscope.This indicates that the SMC in rabbit’s CBD possess contracting function.③The collagenous and elastic fibers have the normal histological morphometric characteristics and quantity in it’s dilatation process,and no breekdown and degeneration of the fibers can be detected.Because of the morphological structure of these sections is quite similiar with normal ones,theoretically,we suspect that when pathological change of bile duct’s distal portion is relieved and the bile pressure is normal again.It is possible for this dilating bile duct to return to its formal shape and size.
ObjectiveTo summarize experience of laparoscopy combined with choledochoscopy common bile duct exploration for patients with schistosomiasis liver cirrhosis with common bile duct stones. MethodThe clinical data of 45 patients with schistosomiasis liver cirrhosis combined with common bile duct stones (liver function Child-Pugh grade A and B) admitted in this hospital from September 2012 to September 2015 were analyzed retrospectively. ResultsTwenty cases were successfully treated by laparoscopy combined with choledochoscopy (laparoscope group), 25 cases were treated by conventional open common bile duct exploration (laparotomy group). Two cases were converted to laparotomy due to bleeding during laparoscopic operation. The mean operation time, intraoperative bleeding, postopera-tive hospitalization time, and postoperative total complications rate had no significant differences between these two groups (P>0.05). There were 2 cases of pulmonary infection and 1 case of incision infection in the laparoscope group, and 1 case of grade A bile leakage and 1 case of pulmonary infection in the laparotomy group, there was no common bile duct stone residual in these two groups. ConclusionAlthough laparoscopic surgery is more difficult for schistosomiasis liver cirrhosis combined with common bile duct stones patients, it is safe and feasible. Appropriate perioperative management and precise laparoscopic and choledochoscopic operation are key to success of operation.
ObjectiveTo 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). MethodsFrom 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. ResultsThe 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. ConclusionFrom 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.
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.
Objective To investigate the effect of laparoscopy combined with choledochoscopy on common bile duct (CBD) stones with primary suture of the CBD. Methods Totally 523 patients of gallbladder stone companied with CBD stones or choledochectasia (diameter ≥0.8 cm) from September 1998 to December 2008 were retrospectively analyzed. Results The primary suture of the CBD incision was successfully performed in 487 patients. The CBD stones were completely removed during the operation in 400 patients. Nothing was found in 87 cases. In 10 cases conversion to open surgery were performed and in 26 cases the T tube drainage was put into the CBD in choledocholithotomy. Average operative time was 90 min and average bleeding volume was 50 ml. All patients took food at 24 h, returned general activity on 2-3 d and discharged on 5 d after operation. Postoperative biliary leakage occurred in 29 cases with drainage average volume of 35 ml/d and continued 1-6 d, which were cured by non-operation therapy. Conclusions The primary suture of the CBD during the laparosocopy combined with choledochosopy in choledocholithotomy is a safe and effective operation with less invasion, less pain and quicker recovery. CBD incision suture without T tube drainage can be done when CBD stones are cleared completely and no stenosis is found in extrahepatic bile duct.
ObjectiveTo compare the cost-effectiveness between endoscopic retrograde cholangio-pancreatography (ERCP) treatment and laparotomy treatment for simple common bile duct stone or common bile duct stone combined with gallbladder benign lesions. MethodsA total of 596 patients with common bile stone received ERCP (ERCP group) and 173 received open choledocholithotomy (surgical group) in our hospital between January 2009 and December 2012. Their clinical data were retrospectively analyzed. The curing rate, postoperative complications, hospital stay, preoperational preparation and total cost were compared between the two groups of patients. Meanwhile, for common bile stone combined with gallbladder benign lesion, 29 patients received ERCP combined with laparoscopic cholecystectomy (LC) (ERCP+LC group), 38 received pure laparoscopy treatment (laparoscopy group) and 129 received open choledocholithotomy combined with cholecystectomy (surgery group). ResultsFor simple common bile stone patients, no significant difference was found in cure rate and post-operative complication between endoscopic and surgical treatment groups (P>0.05). However, total hospitalization expenses[(13.1±6.3) thousand yuan, (20.6±7.5) thousand yuan)], hospital stay[(8.91±4.95), (12.14±5.15) days] and preoperative preparation time[(3.77±3.09), (5.13±3.99) days] were significantly different between the two groups (P<0.05). For patients with common bile stone combined with gallbladder benign lesion, no significant discrepancy was detected among the three groups in curing rate and post-operative complications (P>0.05). Significant differences were detected between ERCP+LC group and surgical group in terms of total hospitalization expense[(18.9±4.6) thousand yuan, (23.2±8.9) thousand yuan] hospital stay[(9.00±3.74), (12.47±4.50) days] and preoperative preparation time[(3.24±1.83), (5.15±2.98) days]. No significant difference was found in total hospitalization expense and hospital stay, while significant difference was detected in preoperative preparation time between ERCP+LC group and simple LC group. ConclusionFor patients with simple common bile stone, ERCP is equivalent to surgery in the curing rate, and has more advantages such as less cost, shorter length of hospital stay, and lower preoperative preparation time. For the treatment of common bile duct stone with gallbladder benign disease, ERCP combined with LC also has more advantages than traditional surgery.
ObjectiveTo investigate the clinical significance of abnormal confluence of common bile duct (CBD) and pancreatic duct. MethodsFortyfive cases of biliary pancreatic confluence portion of cadavers were dissected and observed with microscope. ResultsThe lower end of CBD inserted normally into the medial posterior portion of descending duodenum with oblique angle (41.4±5.3)° and safeguarded by the sidelong wrinkle formed by mucous membrane of duodenum. In common, pancreatic duct ampulla inserted into CBD with oblique angle (28.5±7.9)° and jointed CBD in the medial wall of dudenum. The length ampulla of Vater was about 0.5-1.5 cm. The Vater’s ampulla was dilated obviously. ConclusionThe result indicates that pancreatic duct and CBD joint with a sharp angle. A number of abnormal anatomic factors may change the relation of oblique angle, and lead to the pancreatitis.
Objective To prevent bile duct injury, a new anatomy marker, named “common bile duct window” is created. Methods From November 2005 to March 2006, 60 patients who underwent laparoscopic cholecystectomy were researched in this hospital. All data were collected, including: age, gender, course of disease, body mass index (BMI), blood lipid level (triglyceride and cholesterol), the thickness of gallbladder wall and the degree of cholecystitis. The frequency, location and mean size of “common bile duct window” were recorded and calculated. Patients were divided into two groups according to the presence of “common bile duct window”, and the diference of data between two groups was analyzed by using χ2 test or t test. Results “Common bile duct window” was found at the end of hepatoduoduenal ligament with oval-shaped, the mean longitude of “common bile duct window” was (1.20±0.60) cm, and mean width was (0.45±0.30) cm. “Common bile duct window” were found in 81.6% (49/60) of patients. Age, gender, course of disease, BMI, triglyceride and cholesterol were proved to have no relationship with the presence of “common bile duct window” （Pgt;0.05）, but the thickness of gallbladder wall and the degree of cholecystitis affected the presence （P＜0.05）. Conclusion An oval-shaped “common bile duct window” can be found in almost all patients undergoing laparoscopic cholecystectomy. During the operation, the common bile duct can be located easily by the surgeon through “common bile duct window”, thereby to avoid common bile duct injury when the cyst duct was dissected. It is believed that during laparoscopic cholecystectomy the chances of bile duct injuries can be effectively decreased by the presence of “common bile duct window”.
ObjectiveTo evaluate the value of magnetic resonance cholangiopancreatography (MRCP) on prevention of the complications in laparoscopic cholecystectomy (LC). MethodsThe clinical data of 1 079 patients underwent LC from January 2006 to June 2010 in this hospital were retrospectively analyzed. According to the use of MRCP or not in the different period, the patients were divided into nonMRCP group (n=523) and MRCP group (n=556). The occurrence of bile duct injuries (BDI) and retained common duct stone (RCDS) were compared between two groups. ResultsConversion to open surgery was performed in 35 cases in nonMRCP group and in 41 cases in MRCP group. The intraoperative and postoperative BDI were found in five patients and RCDS were found in 27 patients in nonMRCP group, and those were not found in patients in MRCP group. The differences of BDI and RCDS of patients were significant between two groups (P=0.026 and P=0.000). In nonMRCP group, 23 of 55 patients were found common bile duct stones by intraoperative cholangiography. Common bile duct stones were found by intraoperative cholangiography other than preoperative MRCP in three patients in MRCP group, while another three patients did not find common bile duct stones by intraoperative cholangiography although preoperative MRCP suggested. By MRCP, double gallbladders were found in one patient, Mirizzi syndrome in eight patients, variant cystic duct in 34 patients, accessory hepatic duct in 28 patients, and complicating common bile duct stones in 27 patients in MRCP group, the diagnostic accuracy of those were 100%, 87.5%, 94.1%, 89.3% and 88.9%, respectively. ConclusionPreoperative MRCP is helpful to prevent BDI and RCDS for the patients with LC.
Objective To study the effect of laparoscopic common bile duct exploration via choledochotomy and T tube drainage. Metheods Laparoscopic exploration of common bile duct with choledochoscopy via choledochotomy was performed in 105 patients, T tube was placed in all patients with laparoscopic suturing technique.Results Except negative exploration in 2 cases, duct clearance was achieved in 99 per cent (102/103) of patients. Conclusion Laparoscopic exploratoin of common bile duct via choledochotomy and T tube drainage is one of the safe and effective management options for common bile duct calculi.