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0.05),but incidence of postoperative complications and residual calculus in LC+LCBDE group were significant lower than those in LC+EST group.Conclusions Combining LC with LCBDE is a feasible treatment for cholecystolithiasis and choledocholithiasis.
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Objective To explore the appropriate operative methods for the treatment of CBD(common bile duct) stone in endoscopic era.Methods We retrospectively analyzed the diagnosed and treated data of 309 patients with suspected CBD stones with ERCP,LC+ERCP and LECBD(laparoscopic exploration of the commonbile duct) from January 2004 to July 2008 in our hospital.Results A total of 216 patients receivedERCP,among them 97(44.9%) cases had CBD stone,and there was the trend that the number of patients who received ERCP reduced yearly.Among the 93 patients who received LECBD,71 cases were successful and 22 cases were converted to open operation.Of the 71 cases,transcystic duct CBD exploration was done in 11 cases,direct CBD exploration in 60 cases,and 6 cases had primary closure of CBD.The number of cases that received LECBD grew steadily with time.There was no difference in successful operative rate,intraoperative bleeding and residual calculi rate between ERCP+LC and LECBD group.The operative time,postoperative complications and length of hospital stay in LECBD.group were significantly lower than those in LC+ERCP group.Conclusions LECBD is better than LC+ERCP in the treatment of CBD stones,but in the endoscopic era,the selection of an individualized treatment approach is the best operative method for the management of CBD stone.
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Objective To study the therapeutic effects of combined use of laparoscopic cholecystetomy and endoscopic sphincterotomy for cholecystolithiasis with secondary choledocholithiasis.Methods Thirty-five patients were diagnosed as cholecystolithiasis with secondary choledocholithiasis by B-ultrasonography and magnetic resonance cholangiopancreatography.Of them,in 28 cases,laparoscopic cholecystetomy was performed first,and ERCP and endoscopic sphincterotomy were done one week later;in 7 cases,endoscopic sphincterotomy were performed before laparoscopic cholecystectomy.Results The outcome of all the thirty-five cases was satisfactory without severe complications or conversion into open procedure.Conclusions The method of combined laparoscopic cholecystomy and endoscopic sphincterotomy,for cholecystolithiasis with secondy choledocholithiasis,especially for cases in whom the diameter of the common bile duct stone is ≤1cm,can give good therapeutic results and has advantages of minimal invasiveness,few complications and quick recovery.
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Objective To discuss the clinical value of modified laparoscopic lithotomy of common bile duct.Methods Clinical data of 78 patients over the age of 60 with gallstone and choledocholithiasis who underwent modified laparoscopic lithotomy of common bile duct in the past four years were analysed.Results All operations were successful.T-tubes were withdrawn 4 weeks after operation.Of the 78 cases,77 cases hat no complications and only one case had a small incision infection.All patients recovered without complications after with drawal of T-tube.Conclusions Modified laparoscopic lithotomy of common bile duct can allow incision and suture of common bile duct and placement of T-tube under direct vision,and achieves excellent therapeatic results in the treatment of common duct stones,especially in elderly patients who cannot tolerate a long period of pneumoperitoneum.
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Objective To compare the clinical results of choledocholithotomy by laparoscopic surgery and open surgery.Methods One hundred and Sixty-nine patients with cholecystoithiasis combined with choledocholithiasis were divided into laparoscopic surgery group(85 cases of laparoscopic choledocholithotomy,LCD-TD) and open surgery group(84 cases of open choledocholithotomy,OCH-TD).The clinical data in the two groups were compared and analyzed.Results The amount of intraoperative bleeding,the recover time of intestinal peristalsis after treatment,length of hospital stay,cases of postoperative pain and biliary fistulas in laparoscopic surgery group were evidently better than those of open surgery group(all P
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Objective To explore the method and effect of primary closure of choledochostomy with placement of a modified biliary stent after common bile duct exploration. Methods Open or laparoscopic common bile duct exploration was done in 39 patients with both gallbladder and common bile duct (CBD) stones. After extraction of stones, an 8F J-stent (pigtailed) was placed in the CBD and into the duodenum over a guide wire. The proximal end of the stent was secured to the CBD wall with rapidly absorbable suture. The CBD incision was primarily closed. Results The stent dislodged and was discharged with stool at the 13th (10-18) postoperative day . Three patients developed transient hyperamylasemia in the immediate postoperative period. None of the patients had complications of bile leak, stent occlusion, early stent dislodgement, or stent retraction into the CBD. Conclusions Placement of a self-release biliary J-stent in CBD and into the duodenum during common bile duct exploration is easier to manipulate with the help of choledochoscpe and guide wire. It is safe and cost-effective, therefore, it can expand the indications for primary closure of CBD incision, and reduce the complications related to T-tubes.