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Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.
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Humans , Choledocholithiasis/surgery , Common Bile Duct/surgery , Gallstones/surgery , Laparoscopy/methods , Retrospective StudiesABSTRACT
RESUMEN Antecedentes: la prevalencia conjunta de litiasis vesicular y coledociana aumenta con la edad y llega al 15% en la octava década de la vida. Su manejo continúa siendo controvertido: algunos profesionales prefieren el abordaje en un tiempo por videolaparoscopia, y otros, el abordaje en dos tiempos con endoscopia (CPRE preoperatoria) seguida de colecistectomía laparoscópica. Objetivo: evaluar la eficacia y seguridad del manejo en un tiempo por videolaparoscopia en pacientes consecutivos con diagnóstico de litiasis vesicular y coledociana. Material y métodos: estudio retrospectivo con datos de una base de datos prospectiva, entre julio de 2008 y julio de 2018. Resultados: sobre un total de 2447 colecistectomías laparoscópicas realizadas en el citado período, 416 (17%) presentaron litiasis coledociana. El éxito global de la vía transcística en la extracción de litiasis coledociana fue del 81,2%: del 70,4% en los casos con diagnóstico prequirúrgico de colestasis extrahepática litiásica y del 92,9% en los otros diagnósticos. La morbilidad fue del 4%, sin mortalidad ni lesiones quirúrgicas de la vía biliar. Conclusión : el manejo en un tiempo por videolaparoscopia es eficaz y seguro debido al elevado éxito global de la instrumentación transcística (ITC). El diagnóstico preoperatorio de coledocolitiasis condi ciona una disminución de esa eficacia, por mayor indicación de coledocotomía, con un aumento de la morbilidad y del tiempo de internación.
ABSTRACT Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.
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Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Laparoscopy , Cholelithiasis , Efficacy , Retrospective Studies , Choledocholithiasis , EndoscopyABSTRACT
La exploración laparoscópica de las vías biliares (ELVB) constituye, hoy en día, una herramienta de gran utilidad en el tratamiento de la patología litiásica del árbol biliar, especialmente cuando técnicamente sea imposible realizar una pancreato-colangiografía retrógrada endoscópica (PCRE) o en los casos en los cuales este estudio no esté disponible. Método: Describir mediante un video nuestra técnica de ELVB paso a paso, en una paciente de 41 años quien consultó por presentar tinte ictérico en piel y mucosas, coluria e hipocolia. El ultrasonido abdominal reportó litiasis vesicular, dilatación de vías biliares intra y extra hepáticas, colédoco de 9 mm de diámetro y múltiples imágenes hiperecogénicas sugestivas de litiasis. Al no poder realizarse PCRE se decide practicar ELVB. Se realizó disección del triángulo biliocístico, identificación y ligadura proximal del conducto cístico con la finalidad de evitar la migración de cálculos a la vía biliar durante el procedimiento, coledocotomía, lavado proximal y distal de la vía biliar, exploración con catéter de Fogarty, coledocorrafia primaria, cisticotomía y colocación de catéter para colangiografía intraoperatoria, constatación de plenificación de las vías biliares sin imágenes de defecto y de adecuado paso del contraste al duodeno, colecistectomía y colocación de drenaje subhepático. Resultados: Paciente evoluciona en forma satisfactoria, egresando al tercer día de postoperatorio sin eventualidades. Discusión: La ELVB con coledocorrafia primaria ha sido descrita como una alternativa viable y efectiva para el manejo de la litiasis biliar, destacando su menor morbimortalidad cuando se compara con procedimientos endoscópicos como la PCRE(AU)
Laparoscopic common bile duct exploration (LCBDE) constitutes, nowadays, a very useful tool in the treatment of biliary tree lithiasis, especially when it is technically impossible to perform an endoscopic retrograde pancreatic cholangiography (ERCP) or in cases when this study is not available. Method: Using a video, we describe our LCBDE technique step by step, in a 41-year-old patient who consulted for presenting jaundiced skin and mucosa, coluria and hypocolia. Abdominal ultrasound reported gallstones, intra- and extra-hepatic bile duct dilation, a 9-mm diameter common bile duct (CBD) and multiple hyperechoic images suggestive of lithiasis. Since ERCP could not be performed, it was decided to practice LCBDE. Dissection of the Calot's triangle was performed, identification and proximal ligation of the cystic duct in order to avoid migration of stones to the common bile duct during the procedure, choledochotomy, proximal and distal lavage of the bile duct, exploration with a Fogarty catheter, primary closure of CBD, cysticotomy and placement of catheter for intraoperative cholangiography, verification of fullness of the bile ducts without defect images and adequate passage of contrast to the duodenum, cholecystectomy and placement of subhepatic drainage. Results: Patient progressed satisfactorily, being discharged on the third postoperative day, uneventfully. Discussion: LCBDE with primary closure of CBD has been described as a viable and effective alternative for the management of biliary stones, highlighting its lower morbidity and mortality when compared with endoscopic procedures such as ERCP(AU)
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Humans , Female , Adult , Bile Ducts , Gallstones , Laparoscopy , Common Bile Duct , Pathology , Physical Examination , Cholecystectomy , LithiasisABSTRACT
Objective@#To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.@*Methods@#Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded.@*Results@#In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ2=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ2=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05).@*Conclusion@#The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter.
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Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones.Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group (38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE),and B group (49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC).The curative effect of the two groups was observed.The operation time,the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery,and the complications of the two groups were recorded.Results In A group,the average diameter of common bile duct stones was (1.02 ± 0.25) cm,the average diameter of common bile duct diameter was (1.15 ± 0.25) cm.In B group,the mean diameter of common bile duct stones was (0.99 ± 0.26) cm,and the average diameter of common bile duct was (1.13 ± 0.26) cm.The differences between the two groups were not statistically significant (t =0.513,0.437,0.367,P =2.083,1.533,1.095).The successful operation rate of A group was 92.11％ (35/38),which in B group was 91.84％ (45/49),the difference was not statistically significant between the two groups (x2 =0.006,P =0.974).The incidence rate of complications in B group was 20.41％,which was significantly higher than that in A group,the difference was statistically significant(x2 =3.654,P =0.019).The hospitalization time,hospitalization expenses in A group were (10.6 ± 2.6) d,(26 649.8 ± 3 478.6) CNY,respectively,which were significantly better than those in B group (t =21.971,17.168,all P ＜ 0.05).Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery,and the safety of the former is higher than the latter.
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Objective To analyze the incidence of choledocholithiasis in patients who underwent cholecystectomy in our hospital,and to determine the incidences of recurrent stones and choledocholithiasis combined with cholangitis after treatment for choledocholithiasis.Methods A retrospective study was conducted on 1 152 patients with common bile duct stones treated from January 2013 to July 2017 in our hospital.Results Of the 1152 patients with common bile duct stones,572 patients had a history of cholecystectomy,accounting for 49.65％ of all patients.402 patients had choledocholoithiasis combined with cholecystolithiasis (34.9％ of all patients),278 patients had choledocholithiasis without cholecystolithiasis (24.1％).Choledocholithiasis could occur after cholecystectomy.The time of onset of choledocholithiasis was 5 ～ 10 years after operation in 49.1％ of patients,and 200 of these patients with choledocholithiasis were treated with lithotripsy.There were 110 patients who underwent choledocholithotomy and cholecystectomy,and 90 patients who underwent ERCP and stone removal.There was no significant difference between the 2 groups (P ＞ 0.05).Choledocholithiasis complicated with cholangitis developed in 511 patients (44.3％ of all patients).These included 437 patients with acute mild cholangitis (85.5％) and acute obstructive suppurative cholangitis (14.5％).Recurrent choledocholithiasis combined with acute cholangitis after choledocholithotomy developed in 51 patients,and recurrent choledocholithiasis combined with cholangifts developed after ERCP in 50 patients.There was no significant difference between the two groups (P ＞0.05).Conclusions Choledocholithiasis after cholecystectomy accounted for a high proportion of patients.Recurrent choledocholithiasis could occur after choledocholithotomy.Common bile duct stones were susceptible to develop cholangitis.Thus,common bile duct stones should be treated as soon as possible.
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Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography ( ERCP ) in the treatment of patients with biliary and pancreatic diseases after Billroth Ⅱ gastrectomy. Methods Clinical data of 178 patients with biliary and pancreatic diseases undergoing 237 times of ERCP at the digestive endoscopy center in Changhai Hospital from January 2011 to December 2016 were retrospectively collected. The success rate of procedures and related complications were summed up. Results Among 178 patients undergoing 237 times of ERCP, the successful intubation rate of the endoscope to reach the duodenal papilla was 83. 5％ ( 198/237 ) . The success rate of selective cannulation and completing the expected intervention were 91. 4％ ( 181/198 ) and 98. 9％ ( 179/181 ) , respectively. The total success rate of ERCP was 75. 5％ (179/237), which had an increasing trend with time. The total success rate of ERCP in patients with common bile duct stone was 85. 2％ ( 127/149) , and the stone retrieval rate during the first session was 56. 7％ (72/127). The ERCP-related complication rate was 14. 3％ ( 34/237 ) , with 1. 7％ ( 4/237 ) perforation, 1. 3％ ( 3/237 ) bleeding, 3. 4％ ( 8/237 ) pancreatitis, and 8. 0％ ( 19/237 ) asymptomatic hyperamylasemia. One patient with perforation and 2 patients with severe pancreatitis died of septic shock and multiple organ failure ( 1. 3％, 3/237 ) . Most ERCP-related complications were improved by conservative treatment or second endoscopic intervention ( 91. 2％, 31/34 ) . Conclusion ERCP is effective and safe in the treatment of biliary and pancreatic diseases in patients with prior Billroth Ⅱ gastrectomy. With the development of endoscopic techniques and experience accumulation of endoscopists, the success rate of intubation, selective cannulation and therapeutic intervention can be close to those of patients with normal anatomy, and the incidence of related complications is low.
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Objective To evaluate the application value of emergency endoscopic needle-knife sphincterotomy(NKS) on acute cholangitis of severe type (ACST) resulting from impacted common bile duct stones at duodenal papilla. Methods A retrospective study was performed on the data of 90 ACST cases with impacted common bile duct stones at the native papilla and undergoing emergency NKS between January 2011 and January 2017 in Tianjin Nankai Hospital. The completion of treatment, mean operating time, impacted stone clearance rate, changes of laboratory indexes before and after endoscopic procedure, and complications were analyzed. Results All the 90 patients underwent emergency NKS successfully, with a total success rate of 100. 0％. The mean operating time was 25. 2±11. 7 min. The impacted stone clearance rate was 95. 6％(86/90). The complication rate was 5. 6％(5/90), including 3 cases of hemorrhage and 2 cases of post-ERCP pancreatitis. There was no procedure-related mortality. The postoperative white blood cell count, serum procalcitonin, total bilirubin, direct bilirubin, and glutamic-pyruvic transaminase decreased significantly compared with pre-operation ( all P<0. 001) . Conclusion Emergency NKS is effective and safe for treatment of ACST resulting from impacted common bile duct stones at duodenal papilla with a relative high application value.
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Objective To investigate the therapeutic effects of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic bile duct exploration lithotomy (LBDEL) in treatment of intra/extra-hepatic duct stones. Methods There were 110 patients whose intrahepatic stones located in Ⅰ , Ⅱ hepatic duct and 378 patients whose stones only located in the common bile duct. These patients respectively underwent LBDE combined with choledochoscope laser lithotripsy or ERCP combined with endoscopic sphincterotomy (EST) and endoscopic nasobiliary drainage (ENBD) to remove the stones. Common bile ducts were performed primary suture or T tube placement in the LBDEL cases. The evaluation was carried out for perioperative complications and postoperative recovery of the surgical methods. Results The residual stone rate was 31.82% in 110 cases. The rate was higher in ERCP group (51.06%) than that in LBDEL group (17.46%) (P < 0.05). Postoperative recovery was better in LBDEL group than that in ERCP group. The residual stone rate was 8.20% in 378 cases. The rate was lower in ERCP group (3.68%) than that in LBDEL group(11.63%) (P < 0.05). Between the two groups, there had no statistical significance in postoperative recovery. The incidences of bile leakage and pulmonary infection were higher in LBDEL group than in ERCP group. The incidences of abdominal cavity infection, acute pancreatitis, digestive tract perforation and gastrointestinal bleeding were higher in ERCP group than that in LBDEL group. 2 of the 378 patients occurred death were happened digestive tract perforation which were induced during ERCP procedure. Conclusion LBDEL and ERCP demonstrated the same therapeutic effects in the treatment of common bile duct stones. However, ERCP has no large advantages in the treatment of hepatolithiasis, and shows higher complication rates. LBDEL has a significant curative effect for intra-and extrahepatic bile duct calculi and can maintain the integrity of Oddi sphincter. This technology is easy to spread to the basic-level hospital to benefit the majority of patients.
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Objective To investigate the improved approach and bile duct approach of laparoscopic biliary tract exploration for the treatment of the elderly patients with common bile duct stones. Methods Ninety-two elderly patients with common bile duct stones were enrolled and randomly divided into the improved group and the conventional group ,with 46 cases in each group. The time of hemorrhage ,the time of common bile duct suture,the recovery time of gastrointestinal function,the time of hospitalization,body temperature,albumin and total bilirubin levels,complications and recurrence of stones were recorded and compared between the two groups. Results The time of hemorrhage,the time of common bile duct suture,the recovery time of gastrointestinal func-tion and the time of hospitalization in the improved group were lower than those in the conventional group(P<0.05, respectively). The body temperature of patients in the improved group was lower than that in the conventional group on 3 days after surgery(P<0.05). The overall incidence of postoperative complications in the improved group was lower than that in the conventional group (P < 0.05). No recurrence of stones was observed in both two groups. Conclusion The improved approach for laparoscopic common bile duct exploration surgery results in less bleed-ing,short common bile duct suture time,rapid postoperative recovery,less body temperature fluctuations and less complications,deserving popularization.
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Objective To investigate the short term efficacy and security of different diameters of ampulla balloon dilation in the treatment of choledocholithiasis. Methods 80 patients with extrahepatic bile duct stones treated by EPBD were included in this study. All the patients were divided into 8 mm group, 10 mm group, 12 mm group, 14 mm group, which were according to the diameter of common bile duct (CBD) and stones. CBD stones were removed with retrieved balloon, Dormia basket, and/or mechanical lithotripsy if necessary. The incidence of 24 h hemorrhage, acute pancreatitis, hyperamylasemia and intestinal perforation were observed, and the incidence of pneumobilia and duodenobiliary reflux two weeks after EPBD. Then analyzed the short-term efficacy of the four groups. Result The overall success of stone removal in all groups were 100.0%, there was no significant differences in bleeding, intestinal perforation, hyperamylasemia, pancreatitis between each group (P > 0.05) . There shows significant differences in pneumobilia and duodenobiliary reflux two weeks after EPBD (P < 0.05). The incidence of pneumobilia and duodenobiliary reflux increased with the size of the balloon. Conclusion The application of EPBD is effective and safe for bile duct stone removal, while with the increasing of balloon diameter, the function of Oddi sphincter has severely influenced.
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Objective To explore the technique of laparoscopic reoperation in the treatment of common bile duct stones.Methods A retrospective analysis of the clinical data of 54 cases of common bile duct stones undergoing laparoscopic common bile duct stone surgery in our hospital from January 2011 to December 2015 was conducted.Through the choice of puncture hole, the exposure of the liver surface and the confirmation of the common bile duct, T-tube drainage and primary suture of common bile duct were carried out for the treatment of bile duct stone.Results The laparoscopic operations were successful in 52 cases, while conversions to open surgery were required in 2 cases.During the operation, the amount of bleeding was about 40-150 ml (average, 70 ml), the operation time was 75-180 min (average, 120 min), and the postoperative gastrointestinal function recovery time was 24-48 h (average, 27±13 h).There were 1 case of duodenal perforation injury, 2 cases of bile leakage, and 2 cases of residual stones after operation, which were cured with laparoscopic repair, prolonged drainage time, and choledochoscope treatment via abdominal sinus.Postoperative hospital stay was 6-9 d (average, 7±1.5 d).A total of 54 cases were followed up for 3-24 months (mean, 14.8 months).All the patients recovered well, without bile duct stricture or stone recurrence.Conclusion As long as the application of skilled laparoscopic surgery methods and separation of surgical area skills, laparoscopic bile duct surgery for the treatment of common bile duct stones is safe and feasible.
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Objective To discuss necessity of cholecystectomy for patients with stones in their bile ducts and gallbladders in the absence of absolute operation indications of cholecystectomy after clearance of bile duct stones with ERCP. Methods Data of less than 70-year-old patients with stones in their bile ducts and gallbladders but without absolute operation indications of cholecystectomy admitted to the First People′s Hospital of Hangzhou from January 2012 to December 2014 were retrospectively analyzed. Patients were divided into cholecystectomy group and gallbladders in situ group after bile duct stones removal with ERCP. The hospitalization time, recurrent biliary events, complications of operation were compared between two groups. Results A total of 128 patients were included and followed up for(24.031±9.170)months with 64 cases in conservative group and 64 cases in cholecystectomy group. Incidence of recurrent biliary events in the cholecystectomy group and conservative group were 7.8%(5/64)and 10.9%(7/64)(P=0.544). Among cases of recurrent biliary events,incidences of cholangitis in the two groups were 7.8%(5/64)and 4.7%(3/64)respectively(P= 0.465), incidences of pancreatitis were 0(0/64)and 1.6%(1/64) respectively(P=0.315), incidences of common bile duct stones were 7.8%(5/64)and 7.8%(5/64)respectively(P = 1). No recurrent cholecystitis occurred. There were no differences in ERCP-related complications between the cholecystectomy group[23.4%(15/64)]and the conservative group[12.5%(8/64)](P=0.107). But 4 patients(6.3%)in cholecystectomy group had LC-related complications during the follow-up period, 3 cases of infection and 1 ileus. The hospital stay in conservative group was shorter than that in cholecystectomy group(5.906± 4.614 days VS 14.313± 6.312 days, P<0.001). The hospitalization expenses in two groups were(45 196± 12 518)yuan and(22 160± 11 755)yuan(P<0.001). Conclusion Conservative methods yield to shorter hospitalization and lower expenses without cholecystectomy-related complications. Conservative management for gallbladder stones after ERCP for biliary duct stones is recommended for patients who had no absolute operation indications of cholecystectomy.
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Common bile duct stones are among the most common diseases in elderly patients.In the past 20 years,minimally invasive techniques,including endoscopic retrograde cholangiopancreatography and laparoscopic common bile duct exploration,have been developed rapidly and provided more options for patients.Choosing appropriate treatment plans will help reduce postoperative complications and lead to better outcomes in elderly patients with common bile duct stones.
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Objective:To observe the surgical effects of laparoscopy and choledochoscope combination in the treatment of common bile duct stones and the complications occurrence situation,so as to provide reference for the clinical surgical treatment for common bile duct stones.Methods:The clinical materials of 120 common bile duct stones received surgical treatment in the Hepatobiliary Surgery of our hospital from January 2013 to January 2015 were retrospectively analyzed,and were divided into two groups according to the surgical approaches.The control group were given conventional open cholecystectomy,and the research group were given laparoscopy and choledochoscope combination surgery.The surgical situations and complications in these two groups were observed.Results:The surgical time in the research group was significantly longer than in the control group (P＜0.05),the blood loss,gastrointestinal recovery time,ambulation time,hospital stay were significantly shorter than in the control group (P＜0.05);the complication incidence such as pain,infection,bile leakage,residual stone in the research group was 8.3％,significantly lower than 21.7％ in the control group (P＜0.05).Conclusion:The combination treatment of laparoscopy and choledochoscope in the common bile duct stones has good curative effects,less blood loss,rapid recovery,and less impact on the gastrointestinal function,low incidence of complications,and can significantly shorten the length of hospital stay,can be used as the first choice in clinical practice.
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Objective To investigate the safety and efficacy of endoscopic duodenal papillary muscle small incision(EST)combined with duodenal papillary balloon dilation(EPBD)in the treatment of elderly patients with bile duct stones.Methods 100 elderly patients with bile duct stones were treated with endoscopic stone removal. Among them,55 patients were treated with SEST combined with EPBD(EPBD group),45 patients were treated with a single EST(EST group),the rate of stone removal,the occurrence rate of lithotripsy and the incidence of complications were compared between the two groups.Results The SEST +EPBD group at a time calculi clearance rate,postopera-tive hyperamylasemia,post pancreatitis,cholangitis were 98.2%,7.3% and 3.6%,1.8%,the EST group were 97.7%,6.7%,6.7%,3.6% and the difference between the two groups had no significant(all P >0.05).The SEST+EPBD group of gravel formation rate was 3.6%,lower than 13.3% in the EST group,the difference was statistically significant(χ2 =9.647,P <0.05).The SEST +EPBD group had no bleeding,bleeding in EST group incidence rate was 11.1%,the difference was statistically significant(χ2 =11.235,P <0.05);The recurrence rate of the SEST +EPBD group was 1.8%,which was lower than 11.1% in the EST group,the difference was statistically significant (χ2 =10.113,P <0.05 ).Conclusion EST combined with EPBD in the treatment of elderly common bile duct stones is safe and effective,which can significantly reduce the incidence of debris and bleeding,reduce the recurrence rate of common bile duct stones.
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Objective To explore the feasibility of laparoscopic common bile duct exploration without T-tube drainage.Methods A to-tal of 37 patients who were addmitted into our hospital from May 2014 to August 2015 with common bile duct stones were analyzed.Among these patients,22 cases were given T-tube drainage while the other 15 cases were not.The operation time,hospitalization expenses,anal ex-haust time,postoperative hospitalization time,bile leakage rate and the satisfaction of patients after surgery in the two groups were observed. Results In the non-T-tube group,the anal exhaust time was (1.41 ±0.82)d and the hospitalization time was(4.82 ±1.61)d,which were lower than(3.81 ±1.09 )d and (11.17 ±1.19 )d respectively in the T-tube group,and the differences were statistically significant (P <0.05).The number of bile leakage (0%)in the non-T-tube group was also significantly lower than 31.82% in the T-tube group (P <0.05).The satisfaction rate of patients in the non-T-tube group(100%)was significantly higher than that in T-tube group (50%),and the difference was statistically significant(P <0.05).Conclusion The laparoscopic common bile duct exploration without T-tube drainage is feasible and it can be popularized in clinic.
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Objective To study the effectiveness and safety of different endoscopic papillary balloon dilation time in treatment of common bile duct stones. Methods 45 patients with common bile duct stones received ERCP treat﹣ment, and they were randomly divided into short-term and long-term balloon dilatation group, then compared opera﹣tive time, intraoperative and postoperative complication rate, hospitalization days and the total cost of hospitalization between the two groups. Results Short-term group included 22 people, the long term group included 23 people, there were no significant difference in stones' size, number and diameter of common bile duct between the two groups (P> 0.05), however, the success rate of surgery, time of stones' extraction, intraoperative complications and postoperative fistula were significant differences (P<0.05). Conclusion Long-term balloon dilation during ERCP for treatment of common bile duct stones can improve the success rate of stone removal and reduce complications.
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Objective To investigate the clinical effects and safety of combination of open and laparoscopic surgery in treatment of elderly patients with gallbladder stones combined with common bile duct stones. Methods 140 elderly patients with gallbladder stones combined with common bile duct stones from May 2014 to May 2015 were randomly divided into control group (65 patients) with traditional open surgery and observation group (65 pa﹣tients) with combination surgery; then compared the perioperative clinical indicators, the total removal rate of stone, the postoperative analgesic used rate and postoperative complications incidence of the two groups. Results The oper﹣ation time, intraoperative blood loss volume, the exhaust time for first time and hospital staying time of observation group was significantly better than control group (P 0.05). The postoperative analgesic used rate of observation group was sig﹣nificantly lower than control group (P< 0.05). The postoperative complications incidence of observation group was significantly lower than control group (P< 0.05). Conclusion Compared with traditional open surgery, combination surgery in treatment of elderly patients with gallbladder stones combined with common bile duct stones can efficient﹣ly shorten the operation time, speed up the recovery process, reduce the degree of trauma and postoperative pain and helpful to prevent the postoperative complications.
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Objective To evaluate the clinical efficacy of small endoscopic sphincterotomy combined large-bal-loon dilation in treatment of common bile duct stones 1.0~2.5 cm in diameter. Methods 426 patients with large common bile duct (CBD) stones 1.0~2.5 cm in size were reviewed in our hospital between June 2010 and June 2014. They were randomized underwent small endoscopic sphincterotomy combined large-balloon dilation (SESPLBD) (n=218) or endoscopic sphincterotomy (EST) ( n= 208) for lithotripsy. The therapeutic outcome and complications were reviewed and compared. Results SESPLBD had higher complete duct clearance in one session (95.41 % vs. 93.75%), but there was no statistical significant difference. Bleeding was much less occurred in SESPLBD than in EST (2.29 % vs. 7.69 %, P= 0.025), especially when the stones were bigger than 1.5 cm in diameter. Mechanical lithotripsy was performed less in SESPLBD (13.76%vs 25.96 %, P=0.002), especially when the stones were 1.5 ~2.0 cm in diameter. There was no statistical significant difference in the incidence rate of post-ERCP pancreatitis (9.17 % vs. 6.73 %,P = 0.452), hyperamylasemia (19.72 % vs. 18.27 %,P = 0.796), perforation and death. Conclusions SESPLBD could be a safe method for large bile duct stones 1.0~2.5 cm in size. Compared with routine EST, it had less bleeding rate and mechanical lithotripsy requirement without increasing the incidence rate of post-ERCP pancreatitis or hyperamylasemia.