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Objective To investigate the clinical efficacy of primary closure in laparoscopic common bile duct exploration (LCBDE).Methods The retrospective cross-sectional study was conducted.The clinicopathological data of 2 429 patients who underwent primary closure in LCBDE in the Second Hospital of Chengdu City from March 1992 to December 2017 were collected.Patients underwent laparoscopic cholecystectomy (LC) + stone extraction using LCBDE or extracorporeal shock wave lithotripsy (ESWL),laparoscopic endoscopic sphincteropapillotomy (LEST) was performed selectively,then underwent laparoscopic endoscopic nasobiliary drainage (LENBD) or laparoscopic transabdominal antegrade-guide common bile duct stent implantation,finally underwent primary closure of common bile duct.Observation indicators:(1) surgical situations;(2) postoperative recovery;(3) postoperative short-term complications;(4) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to observe long-term surgical complications once every 3 months up to 1 year postoperatively.Measurement data with normal distribution were represented as (x) ± s.Measurement data with skewed distribution were described as M (range).Results (1) Surgical situations:of 2 429 patients,2 251 underwent successful stone extraction using LCBDE,relief of the obstruction and primary closure of common bile duct,with depletion of stones;15 underwent stone extraction using conversion to open surgery,with depletion of stones;163 had residual stones or surgery-related complications.Of 2 429 patients,1 144,898,223,110 and 54 were respectively detected in grade N or 0,1,2,3 and 4 of laparoscopic distal of the common bile duct smooth classification (LDSC);599 underwent LEST,367 underwent LENBD,207 indwelled urinary catheter through cystic duct stump,125 underwent laparoscopic transabdominal antegrade-guide common bile duct stent implantation and 1 131 underwent primary closure in LCBDE only.Number of removing the stones,diameter of common bile duct,volume of intraoperative blood loss and operation time was (2.5±0.2)per case,(0.7±0.4)cm,(22.4±2.6)mL and (100±12) minutes,respectively.(2) Postoperative recovery:time of postoperative gastrointestinal function recovery,duration of hospital stay and treatment expenses were respectively (2.5±0.5) days,(7.3± 1.2) days and (2.7±0.3) × 104 yuan.Of 2 429 patients,367 removed nasobiliary catheter at 3-7 days postoperatively,207 removed urinary catheter at 3-6 weeks postoperatively,and 125 removed common bile duct stent through duodenoscope port at 1-4 months postoperatively.(3) Postoperative short-term complications:incidence of postoperative short-term complications in 2 429 patients was 6.711％ (163/2 429).① Ninety-four patients with bile leakage were cured after drainage and symptomatic and supportive treatment.② Of 29 patients with residual stones:25 with residual stones of common bile duct were cured by stone extraction using endoscopic sphincterotomy of duodenal papilla,and 4 with residual stones of intrahepatic bile duct didn't receive treatment.③ One patient died at 15 days after surgery for pancreatic cancer.④ Of 39 with postoperative other complications:2 with postoperative hemorrhage were cured by laparoscopic reoperation;12,19 and 3 were respectively complicated with postoperative inflammatory stenosis of duodenal papilla induced to short-term obstructive jaundice,mild acute pancreatitis and stress ulcer bleeding of upper digestive tract,and they were improved by endoscopy or non-operation treatment;2 with stenosis of bile duct didn't receive treatment;1 had a miss ligation at bending section of front zone of nasobiliary catheter,and ligation was removed by endoscopic retrograde cannulation of the pancreatic at 19 days postoperatively.(4) Follow-up situation:of 2 429 patients,1 749 were followed up for 3-12 months,with a median time of 6 months.During the follow-up,of 1 749 patients,2 had mild stenosis in the primary closure area of common bile duct incision and 1 had stenosis of duodenal papilla,they were not treated,and other patients didn't have related complications.Conclusion Controlling strictly the operative indication,primary closure of common bile duct in LCBDE is safe and feasible,with satisfactory clinical outcomes.
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Objective To study the effects of different intervention time of percutaneous transhepatic gallbladder catheterizing drainage (PTGBD)on severe acute biliary pancreatitis Methods Totally 64 patients with severe acute biliary pancreatitis in Affiliated Hospital of Hebei University from July 2013 to July 2017were selected and divided into 3 groups according to the time from attack to PTGBD:group A (less than 72 hours,n =28),group B (from 72 hours to 120 hours,n =22),group C (from 120 hours to 148 hours,n =14).Intergroup comparison of level of WBC,CRP,TBIL,PLT and APACHE-Ⅱ Score,disappearance time of abdominal sign,incidence of pancreatic abscess,length of stay (LOS),mortality and patient satisfaction 48 hours before and after PTGBD were conducted.Results Compared with those in group B and C,all laboratory indexes,APACHE-ⅡScore,disappearance time of abdominal sign,incidence of pancreatic abscess,LOS,mortality and patient satisfaction in group A were all significantly different (P ＜ 0.05).Conclusion Early PTGBD (within 72 hours)can be effective and safe for the treatment of severe acute biliary pancreatitis,and can shorten LOS and reduce the mortality.
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Objective To compare the therapeutic efficacy of laparoscopic common bile duct exploration (LCBDE) plus laparoscopic cholecystectomy (LC),and endoscopic retrograde cholangiopancretography (ERCP) plus endoscopic sphinetemtomy (EST) plus laparoscopic cholecystectomy (LC) in treatment of acute biliary pancreatitis.Method One hundred and six patients with acute biliary pancreatitis and biliary obstruction underwent minimally invasive surgery between January 2012 and February 2016 in our hospital,including 54 cases received LCBDE + LC (LCBDE group) and 52 cases received ERCP + EST + LC (ERCP group).The operation time,intraoperative blood loss,length of hospital stay,medical expenses and postoperative complications were compared between two groups.Results The operating time in LCBDE group was longer than that in ERCP group [(110.2 ± 11.2) min vs.(100.8 ±22.8) min,x2 =-2.11,P ＜ 0.05],the length of hospital stay was shorter [(10.3 ± 3.8) d vs.(12.6 ±3.4) d,x2 =2.32,P ＜ 0.05],the medical expense was less [(31 245.3 ± 1 237.2) Yuan vs.(42 342.2 ±1 354.3)Yuan,x2 =2.82,P ＜ 0.01].There were no significant differences in intraoperative blood loss [(40.2 ± 10.3) ml vs.(39.3 ± 10.4) ml,x2 =0.88,P ＞ 0.05],the rate of postoperative analgesic use [11.11％ (6/54) vs.13.46％ (7/52),x2 =0.102,P ＞0.05] and the incidence of postoperativecomplications [9.26％ (5/54) vs.11.54％ (6/52),x2 =0.080,P ＞0.05] between two groups.Conclusion laparoscopic common bile duct exploration plus laparoscopic cholecystectomy has advantages of shorter hospital stay and lower medical expenses in treatment of acute biliary pancreatitis combined with biliary infection.
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Objective To evaluate the value of diagnostic negative MDCT cholangiopancreatography in patients with suspected obstructive biliary diseases by receiver operating characteristic(ROC)curve. Methods Dual-phases contrast-enhanced MDCT of the abdomen was performed in 30 patients.Multiplanar reformation,minimum intensity projection and volume rendering were generated using original data in vein phase.By double-blind method,the images were readed by two radiologists.ROC curves were analysed with software SPSS11.5,the different results of reading images between two radiologists was evaluated with Kappa test.Results The Az of the area under the ROC curve of MDCT cholangiopancreatography for the two observers was 0.968 and 0.962 respectively,it was more than 0.9,which showed that the value of diagnosing the suspected obstructive biliary diseases by negative MDCT cholangiopancreatography was good.Kappa index test was satisfactory.Conclusion Negative MDCT cholangiopancreatography may be a routine choice in diagnosing the suspected obstructive biliary diseases.